Heather Burger, Sports Medicine

A Swimmer's Quest to Conquer Hip Pain

When Heather Burger first felt pain in her hip 10 years ago, she didn't know what to make of it.

"It was quite a surprise to me. I had always lived a very active life: hiking, biking, aerobics. Around my 40th birthday, I had a pain in my right hip. I thought I just over-exerted it. But it got worse and worse. I tried physical therapy, but it didn't help," she recalls.

The Bainbridge Island resident didn't want to miss out on her outdoor activities, so she made an appointment with her primary care doctor.

"She did an x-ray and told me I had massive arthritis in my right hip. Her advice was 'take ibuprofen,'" Burger says.

Burger did, but the pain just increased.

"Within a year it was so bad that I wasn't sleeping. I could barely walk. I couldn't even get out of a car without leaning on someone."

Burger sought the advice of three different orthopedic surgeons. She was discouraged when they all gave her similar advice – take ibuprofen. Burger began to lose hope that she would ever be active again.

"When you're in so much pain that you can't sleep, you're crabby all day, you can't function at work, and eventually you start to fall apart physically," she says.

Burger was unwilling to resign herself to a life of pain and inactivity. While searching for information about hip treatments, she found UW Medicine orthopedic surgeon Seth S. Leopold, M.D. She decided to try one more time and made an appointment.

"She was very young for someone with severe hip arthritis, which is a painful condition. Her pain was very limiting," Dr. Leopold recalls.

Dr. Leopold decided to find out what had caused Burger's arthritis.

"He said, 'Do you know why you're here?' I said, "Because I have arthritis in my hip.' And he said, 'Yes, but you have a birth defect that's causing it,'" Burger recalls.

It turned out Burger's hip pain was caused by developmental acetabular dysplasia, a misalignment of the hip joint that she had either been born with or had acquired during childhood as her body grew.

"The large majority of patients who get hip arthritis at a young age — 50 or younger — tend to get it because of a childhood condition. Most don't know they have it until their hip starts hurting," explains Dr. Leopold. "The hip is a ball and socket joint and the surface of the bone is covered with cartilage. It's slippery and rubbery, provides padding, and allows the joint to glide and move freely. With arthritis, the cartilage is worn through. Bone rubs on bone."

"By the time I was 40, I had worn down the cartilage so far that I had the hip of an 80-year-old," Burger says.

Her condition was so severe that Dr. Leopold recommended hip replacement.

"To me, joint replacement surgery is a last resort. I typically recommend a brace, medication or activity modification first. But it became apparent that someone that young wouldn't tolerate the pain and limitations long-term. Her symptoms were too severe," says Dr. Leopold.

"Hip replacement is one of the best interventions available in terms of risk versus reward. Ninety percent of patients get good to excellent results from the surgery," adds Dr. Paul Manner, a UW Medicine orthopedic surgeon who practices with Dr. Leopold at the UW Medicine Hip & Knee Center at Northwest Hospital. "There are a number of approaches to hip replacement surgery, but all of them basically involve a metal shell being inserted into the bone of the pelvis. The head of the femur is removed and replaced with a metal ball that has a shaft attached. The shaft is then inserted into the femur to hold the ball in place."

"Prior to surgery, it's important to visit your primary care doctor to get a clean bill of health. If you smoke, you should stop, and if you are overweight, try to lose a few pounds. My number one advice is: the fitter you are going into surgery, the fitter you will be coming out. If you can get in shape, you will have a much better outcome in the weeks following your hip replacement surgery," advises Dr. Manner.

Burger took that advice to heart.

"I went at the surgery the way I would approach a sports event: research, prepare, then just do it," she says.

"When I woke up after the surgery, the first thing I noticed was the pain was gone. It was the first time in well over a year that I wasn't in pain," she says.

The day after surgery, she started physical therapy.

"We like to get people up on their feet the next day. We encourage them to put weight on their new joint immediately, as soon as they are able. Patients can go home in a few days," explains Dr. Leopold.

Six weeks after surgery, Burger was able to walk without assistance. Just 12 weeks after surgery, she went hiking with her husband for the first time in months without pain.

"I'm so glad I found Dr. Leopold. He inspires confidence, he listens, he shares information so you're part of the decision-making process. I can't say enough good things about him," says Heather.

Simply being pain-free and mobile again wasn't enough for Burger, however. She wanted to be as physically active as she once was. "I had never been a swimmer before the surgery, but I figured it would cause less wear-and-tear on my hip than running," she explains.

Burger started doing short swims and gradually worked her way up to several miles. By July 2013, she was ready to participate in the annual Portland Bridge Swim, an 11-mile swim down the Willamette River.

"I thought that it was a great goal. I figured that I didn't have to win it, I just had to try. I loved every minute of it," she says.

Burger has some advice for people struggling with debilitating pain.

"Don't put things off. You shouldn't have to live in pain. Talk to as many doctors as you need to. Take charge of your own body and life. Your injury doesn't get to define you for the rest of your life. You get to decide how you are going to live."