Nancy Foster looks far younger than her 47 years. This trim and attractive woman is the mother of two children, Tara, 18, and Andrew, 15, both Pine View students. Foster, who smilingly refers to herself as a “domestic engineer,” spends most of her days shuttling them and their friends to and from after-school scholastic and athletic events. An avid skier and fan of soccer and field hockey, Foster also swims, gardens and practices yoga. Her husband, Robert, is co-owner of Foster and Company, a maintenance supply company; he also owns Fast-teks, a computer IT and repair service.
Although she beams with vitality and cheer, Foster hasn’t always enjoyed perfect health. When she was 28, she was rushed to the hospital with a stroke brought on by a congenital heart defect. Foster suffered temporary paralysis but recovered; heart surgery fixed the underlying problem. Then, in 2000, she was skiing and her “knee blew out.” ACL (arthroscopic surgical reconstruction of the anterior cruciate ligament) surgery fixed that, too. She went back to her usual active life again.
Three years ago, something else happened, and this time Foster couldn’t bounce back. She first felt it in yoga class—a searing pain in her inner thigh that felt like a pulled muscle. It hurt like hell. Foster decided to ease up on the yoga and give her body a few days’ rest.
“I really didn’t think too much about it,” she says. She figured the pain would go away. It didn’t. It stayed with her—for months. Foster quit yoga, swimming, gardening and most of her activities.
“So much for my active lifestyle,” she recalls. “I pulled into myself and cut myself off from the world.”
Pain became Foster’s constant companion. Every time she moved, it hurt. One day in Publix, Foster realized she was using a grocery cart as a walker.
“That did it,” she says. “It was time to see a specialist.”
Luckily for her, the doctor she chose was Dr. Edward J. Stolarski, a joint replacement specialist at Kennedy White Orthopedics in Sarasota. His work in cutting-edge hip replacement surgery is renowned, and he clearly loves what he does. When he speaks about it, his enthusiasm shines through in his energetic manner and quick smile. “I love the results,” he says. “I love the changes I make in people’s lives. The only thing I don’t love is giving good people bad news.”
First, the bad news
When Foster met with Stolarski, the news he gave her wasn’t good.
“Nancy had one of the more severe cases of hip damage I’ve seen in someone that young and that active,” he says. “It was clearly affecting her entire life. She was miserable and in constant pain. People in chronic pain are not pleasant people; it impacts everyone around them.”
Before we get to the good part—how Dr. Stolarski helped Nancy Foster became pain-free, active and happy again—let’s take a closer look at the hip and how clinicians like Stolarski diagnose hip damage and treat it.
Here’s a brief guide to the hip and hip pain. As the old spiritual song, Dry Bones, reminds us, the leg bone is connected to the hip bone. More specifically, the hip joint is the point of contact between the leg and the torso. The hip is basically a ball-and-socket joint. The “ball” is the top of the thigh bone—the femur. It swivels inside a socket (acetabulum) portion of the pelvic bones. Arthritis damages the ball portion of the femur. Hip surgery replaces it with an artificial ball and stem that slots into the femur; it also replaces the damaged socket portion of the hip with a smooth new socket.
Basically, the impact from all the shocks absorbed by the legs is transmitted to the hip joint. Over time, that repeated impact can cause damage—osteoarthritis. That’s what happens when the cartilage is gradually worn down in a joint; eventually, enough is worn away that it leads to inflammation of the joint lining. According to Stolarski, wear-and-tear arthritis is the most common cause of hip damage. Not all hip damage is gradual. An injury to the joint can also result in “traumatic arthritis.”
Stolarski adds that hip pain doesn’t always mean hip damage. Sometimes, the source of the pain may be an injury in another area of the body. “For instance, pain that runs down the back of the leg usually isn’t hip arthritis,” he explains. “However, if the patient’s symptoms include decreased mobility in the hip joint accompanied by groin pain, that’s a constant for people with severe arthritis in the hip.”
To diagnose hip damage, Stolarski talks to the patient, gets a history and gives a thorough examination. Finally, he examines the radiological evidence. “X-rays are indispensable in the diagnosis of hip pain,” he says.
In Foster’s case, Stolarski diagnosed avascular necrosis of the femoral head. Thanks to a loss of blood supply, the ball portion of the femur had weakened. That was the source of Foster’s hip pain. What caused the blood loss? “We don’t know,” he says. “But in her case, it was debilitating.”
Even so, that didn’t necessarily indicate hip replacement. “We always begin with conservative treatment,” says Stolarski. Depending on the case, he explains, this can include weight loss, anti-inflammatory medications and ambulatory aids, like a cane.
But Stolarski admits that conservative measures only go so far. Foster’s life was severely affected by the pain. “It’s up to the patient if the chance of being pain free is worth the risk of surgery,” he says. “Nancy was 100 percent sure it was. She wanted to end her disability.”
What is hip replacement?
More than 76 million people in the United States suffer hip pain. Each year, nearly 170,000 undergo total hip replacements. Most cases involve the traditional approach: either posterior or anterolateral surgery. Basically, the surgeon replaces the hip joints through incisions in the back of the legs and hips. Despite advances in these techniques, recovering patients must endure restricted motion and fairly long recuperation times. Until recently, patients had no other choice.
Dr. Erik de Witte changed that. He’s a Belgian orthopedic surgeon and hip specialist who six years ago pioneered a new form of hip replacement surgery: the anterior-supine intermuscular technique (ASI). Surgeons come to him from around the world to learn it. Stolarski was one of them. For the past several years, Stolarski has been heralding this groundbreaking technique far and wide. He gives regular seminars throughout the United States and internationally.
In this approach, the patient lies on his or her back on a specialized surgical table; the surgeon makes the incisions from the front of the body to access the hip joint. “It’s minimally invasive,” notes Stolarski. “The incision is very small. There’s no muscle cut at all.”
More importantly, the surgeon doesn’t have to detach muscle tissue from the femur or pelvis. For the patient, that means greater mobility post surgery and a dramatically reduced recovery time. Post-operative patients regain freedom of movement almost immediately.
Foster was convinced it was exactly what she needed. “I saw Dr. Stolarski in May 2008,” says Foster. “We planned the surgery for July during the school break.” Like a boxer preparing for a prize fight, Foster spent the weeks before the operation preparing herself. She took special care of her body—building up her immune system with organic foods and juices, omega-3 and vitamins. Despite her pain, she swam every day. She wanted to be in as good shape as she could be for the ordeal.
And now the good news
July came—and so did the surgery. The operation took place at Doctors Hospital of Sarasota. After two months of preparation, the surgery itself took less than an hour. When she awoke, Foster says that she was pain free for the first time in a year. That same day, she was up and walking around.
“Let’s put it this way,” she says. “I went into the hospital in terrible pain. I walked out of the hospital two days later without pain. It felt like a miracle!”
Foster began rehabilitation immediately with a therapist who came to her home. For the first five days, she used a walker. The following week, she graduated to a cane. She then spent two weeks in rehab therapy outside of her home. After four weeks, she was back to normal.
“When Dr. Stolarski said I needed a new hip, it was the light at the end of the tunnel,” says Foster. “To me, it was good news. I know that’s not how most people would take it. But before, I only had pain. Now I had an option to get rid of the pain. He explained everything with such clarity that I was able to make an informed decision—the right one. It completely changed my life for the better.”
Her mother’s experience has also deeply affected her daughter, Tara, a high school senior who is contemplating what her focus of study will be in college. Tara was so impressed with the results that she asked Stolarski if she could accompany him on his surgical rounds for a day. He agreed, and she spent 10 hours watching hip and knee replacement surgery. “It was amazing to see how the surgical team worked so well together,” she says. “It was as choreographed as a dance. I didn’t even get sick watching!” Tara says she’s now thinking about studying medicine.
Meanwhile, her mother is back doing all of the things she loves, including yoga and skiing. Stolarski says that Foster can expect her new hip to last at least another 25 years. “We used to tell people to wait until they were older to have a replacement, but that doesn’t make sense anymore,” he says. “Why waste quality of life for any amount of time?”
Kennedy-White Orthopaedic Center, 5741 Bee Ridge Road, Suites 280,370, Sarasota; (941) 365-0655