Dear Dr. Leone, Further, I would contact your insurance carrier and the hospital so you will not be surprised with any unexpected costs. Im hearing no restrictions (once recovery is done) for Anterior, but always some for the other two. 4 mts later am using I have seen 4 surgeons. Patients can also have as little as a 3-inch incision. Low-risk anterior approach patients are those who have significant deformities in their proximal femur as a result of previous trauma or dysplasia, or who have previously suffered from acetabular bone fractures. Similarly, an engaged medical team needs to be available to help with care after surgery. Your article lacks the pros of the AMIS and the cons of min invasive posterior. Always speak to your doctor before acting and in cases of emergency seek It is also possible to have an anterior hip replacement during pregnancy. I prefer reconstructing the most symptomatic side first. Extensive release of the posterior capsule including . How do you ask your doctor the questions you want to ask? I think there may be increased associated complications. Is a prerequisite for THR to have a MRI or Pet Scan? A recent article published by the Journal of Bone and Joint Surgery has demonstrated that the direct anterior hip replacement has more blood loss, a higher risk of intraoperative fractures, an overall higher complication rate and no difference in outcomes versus other techniques. Over the last decade total hip replacements have been performed using 2 main approaches: The posterior approach in which the hip joint is approached from the back by releasing and reflecting the short external rotators and dividing the capsule at the back of the hip; and the anterolateral . Surgical approach is important but its just one of many important variables. Ive since met 3 others who ended up with the mess that Im dealing with also. Each surgeon approaches these issues individually. Upgrade to Patient Pro Medical Professional? I do not do hip arthroscopy. Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. My mom is obese, short and has osteoporosis. Proponents of minimally invasive hip replacement say small-incision operations can lessen blood loss, ease post-operative pain, trim hospital stays, improve scar appearance, and speed healing.. In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. I weigh 185 and am 54 and realize its ideal to lose weight prior to surgery (working on it as always). In hopes that THA would let me live my normal life without arthritis, instead I can barely walk more than 100 yards without having to stop, my gait is crooked causing lower back problems and my personal life is less than perfect. I should think that all your expectations are appropriate for the activities you look forward to, especially considering youve already done so well after your knee replacement. I live in Staten Island and need rt hip replacement. It all comes down to the surgeons comfort as well as the patients. I think it perfectly ok to discuss different approaches and ask for an opinion. Will I still be able to do all of these things? That said, in general people who are longer, more flexible and thin are more easily constructed anteriorly than individuals who are very stiff, contracted, thick, and have acetubular protrusion (a condition when the femoral head wears away the central cartilage and bone of the acetabulum). Also, be aware that as the nerve recovers, the smallest C fibers within the nerve recover first, which can cause a burning discomfort. This absolutely does not require a special table. If youve had a failed hip arthroscopy, almost certainly you also have acetabular pathology and a total hip rather than a partial hip replacement may give you a more consistent, longer-lasting and more perfect result. I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. The surgical "approach" in total hip replacement describes the anatomical pathway and technique that the surgeon uses to access the hip joint to perform the surgery. Glazener C, Fraser C, Hutchison J, Vale L. Single mini-incision total hip replacement for the management of arthritic disease of the hip: a systematic review and meta-analysis of randomized controlled trials. It also is more difficult for patients with some patterns of arthritis such as protrusio, which causes the worn out ball to migrate inward rather than upward into the socket. I also would encourage you to choose your surgeon first not the procedure, approach or prosthesis. I encourage you to do the same. Advantages of an anterior approach to hip replacement A major muscle is not cut during the anterior procedure. Thanks! There are many benefits to posterior hip replacement surgery including a quicker return to daily activities, a more natural feeling hip joint, and a decreased risk of dislocation. I ski, hike (steep terrain) with a pack -about 25 pds, kayak, horse back ride, swim, water ski and bike, which is getting increasingly more difficult. Optimal component positioning also is critically important for the best stability and longevity. Being cared for in a hospital that specializes in joint replacement and has an extensive specialty medical staff also is key. Dr. William Leone. I exhausted all other non-surgical options, such as physical therapy and meds but to no avail, so now plan to have a THR in March. Remember, what youre hoping to do is have a hip construct that will last 20 years or more. Before my hip problems, I really enjoyed playing golf and would like like to play again after surgery. Introduction. He is one of the few surgeons in the U.S. that performs total hip replacement via a superior capsular approach, the most soft tissue-sparing hip replacement available and is an industry educator in the . In my 25 years of practice, the variable that seems to have changed the most is how quickly people recover from this surgery when done well. [QxMD MEDLINE Link]. Very slow recovery. They are encouraged to be very active and most stop using a cane, can drive their cars and are exercising in the pool, just two weeks after surgery. Because the anterior hip replacement surgery is a minimally invasive procedure, no cuts are made to the muscles surrounding the hip. from publication: Current and . This does expose the patient to more radiation but can help with component positioning and sizing. These are all realistic goals. If possible, choose a hospital that specializes in joint replacement and can back that up with excellent statistics and reputation. I deal with major nerve damage on front of thigh, almost whole thigh. Going in for THR in July. The most common reason or diagnosis that leads me to replace the hips of young women is hip dysplasia. In some individuals, it takes much more force and dissection in order to accomplish this (typically, there is significantly more bleeding from an anterior approach compared to a mini-posterior approach). About my surgery: I had to wait 30 hours before surgery, two days later I was released, within two more days I stopped using my walker. A major hip replacement can take up to four months to fully recover from. Once youve decided, you then need to trust that he or she will take the best care of you possible to deliver the best results. I prefer spinal anesthesia when possible because fewer drugs are used and often the experience is gentler. If possible, speak with other health professionals who work at the hospital or at least in the same geographical area. I am experiencing pai. We thank you for your readership. So im going back to the surgeon that did my left hip and left me in agonizing pain for 2 months after procedure. In my experience, usually releasing the ileopsoas tendon insertion onto to lessor trochanter and medial hip joint capsule, and then manually stretching the leg into an abducted position after THR reconstruction, obviates the need for formal release. The surgeon makes 2 incisions one bigger than the other on the rear side and separates the muscle and tendon to get to the hip instead of cutting the muscle and tendons to get to the hip. The surgery time is much less with a single joint and therefore the sterile surgical instruments are opened and exposed to the environment for a shorter time. Stay was 2.5 days. The last page is asking the participant to self score their health that day out of 100. Hip replacement currently consists of two major approaches: direct anterior and anterior approaches. My acyive 60 year old husband is scheduled to have Mini posterior total hip replacement in 6 weeks. Complications associated with an anterior approach hip replacement are similar to those associated with standard hip replacement surgeries. If I can put you on the spot. With SuperPath, there is no surgical dislocation of the hip. Because of this, when you're ready to get up and walk about again, engaging your muscles and hip flexors might be extremely tough. I have been in excruiting pain and unable to do everyday normal activities. Will I still be able to do the things I like to do? Most of my patients now go home the day after their surgery or the next. An anterior hip replacement does not have any limitations based on comfort. Like you said, consistent outcome is important and this surgeon is excellent and I have great faith in him (Im a physical therapist and see his patients post-op so get to see the, at least short term, results myself). After reading a few articles on anterior vs posterior including yours, I know now that his decision to use the posterior approach is the best one for me! I then stage the second surgery as early as 2 or 3 weeks post-operatively. I would anticipate that you would be able to return fully to your activity once the tissues around your total hip heel. Total hip replacement is a step-by-step surgery to replace the hip socket and the ball at the top of the thighbone (femur). Here are a few of the advantages of anterior hip replacement. In my experience, most patients who undergo a total hip replacement dont limp after their surgery and most feel their legs are the same length. Hey, thanks for the forum topic.Thanks Again. I would avoid the metal-on-metal articulation. I am Australian so no business from me but it has helped me become happier with my prospective surgeons judgement that he will offer me a posterior THR (hopefully the minimally invasive) when my insurance allows the procedure to occur. Also I have read that there is a sharp learning curve that must take place in order to do the direct anterior approach. If you are minimally handicapped with discomfort from the non-operated hip and the leg length difference is tolerable or easily managed with a shoe lift or modification, I would consider waiting. A miniposterior approach uses the same intervals as the standard posterior approach but simply less tissue is released for the exposure. The posterior approach is used frequently again, in large part due to the fact that it is an extensile approach. Mine certainly have. I try not to bring up my mess but its hard when its with one 24/7. Very sorry to hear of the difficulties you experienced! Please be aware that this might heavily reduce the functionality and appearance of our site. I definitely would not recommend a hip scope and THR during one anesthetic setting. The femoral nerve functions to extend the knee and also is responsible for sensations over the anterior and medial aspects of the thigh, medial shin, and arch of the foot. I have had problems with my hip for the last several yrs. Ive done PT and plan to continue working on strengthening my core and flexibility of those large muscles. (tho I am sure I asked about it ahead of time), I believe you are having trouble finding definitive answers and recommendations because every surgeon has his or her own recipe and experience and also the medical recommendations keep changing. Hip replacements might keep you out of action for a considerable period. I did have a total knee replaced two years ago. The chances of developing a revision surgery after a posterior hip replacement are low, but you should keep all follow-up appointments with your surgeon and inquire when you can resume activities that go beyond 90 degrees or bend down to pick up something small after your procedure. I believe this is an important discussion you should have with your surgeon preoperatively. My worry is that I will end up with one leg shorter than the other. Start your day off right, with a Dayspring Coffee Obese or extremely muscular people may not be the best candidates for this surgical procedure. Today, everything from tools to techniques has improved. Will I be able to dance, hike, bike, swim, exercise after a 3rd surgery? You can resume your active lifestyle as soon as possible thanks to a new prosthetic hip. As a result of anterior hip surgery, there is little need for any special care. The most important variable is how quickly the person is motivated to return to work. You should consult with your doctor before deciding to have an anterior total hip replacement. respect of any healthcare matters. There are a few complications that can occur with anterior hip replacement surgery. The anterior approach, as a marketing tool, has grown in popularity among surgeons. THOUGHTS? Fitness going into surgery and speed of recovery seems to be a common theme though. My husband has a plastic valve (done in 86) and synthetic assending aorta and triple bypass (done in 2013)very successful surgery. There arent any activities that you can do with a resurfaced hip that you cant do with a total hip. Clearly, he or she has earned your respect and confidence. That I knew this recovery may take 1-2 We can help you make the best decision for your knee replacement, and our friendly staff is available to answer any questions you may have. It is critical to make the right decision regarding anterior hip replacement surgery in each case. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. Once you find that doctor, then you need to put your trust in him or her to help you solve this horrible problem so you can return to being active and productive. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. We want the forums to be a useful resource for our users but it is important to remember that the forums are Finally, many people who are struggling with hip disease experience lower back pain or even sciatic discomfort. Both approaches have been shown to have potential in research. I do not have dials and no one seems to know where the neuropathy stems from. What is SuperPath hip replacement? Kenneth, You saw me in your office yesterday (I am 48 years old) as I had complications following a THR of right hip anterior approach with revision 4 days later for a slipped acetabular and then last week I had a dislocated hip. My second question relates to something you mentioned earlier regarding checking the published track record of the surgical team if I use an HMO, how do I find that information, and how do I know it hasnt been skewed to give more favorable results (lying with statistics)? Also there are concerns about disruption of blood supply to femoral head with this operation. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. I, too, am struggling which approach to have. I think seeing several surgeons for different opinions is good judgment. I wish you a full and satisfactory recovery. I take care of many individuals who have a total knee and hip replacements on the same side. External rotation of your feet should be limited (avoiding them twisting to the outside as Charlie Chaplin does) and hip hyperextension should be avoided. Raleighs orthopaedic clinic is board certified and has fellowship training in total joint replacement. If your surgeon cant answer your questions about hip replacement or provides unsatisfactory answers, you may need to consult another surgeon. Years!! Again, considering my own practice, I routinely see my patients recover faster and easier after their second hip or knee replacement because they are more confident having had a good first experience. Often in this group of patients, their X-rays show only minimal cartilage space compromise (it may appear thinned and irregular) and I observe at time of surgery that the labrum appears hypertrophied (to compensate for lack of head coverage) and often torn. I have linked back to several blog posts below that will give you more in-depth information. Most doctors have and continue to implant hips through the posterior approach. If you decide to have your hip replaced in another country, I would consider carefully who would care for you if you develop a complication such as an infection, or a major medical problem like a pulmonary emboli or heart attack after surgery. Many manufacturers are responding to the surgeons desire for shorter stems and many are now available on the market. I am deciding that my quality of life is in the toilet and need to get the THR done. Most patients are able to walk the day of surgery. Your symptoms still sound mechanical, positional and episodic. The rest is marketing. If an MRI demonstrates no cartilage damage or subchondral cystification (the development of degenerative cysts), a repairable labral tear and minimal dysplasia, then a hip arthroscopy may be considered. Some patients report that symptoms increase in the not-yet reconstructed hip because of the leg length inequality. I love that you take time off to reply to these messages it is commendable. The new femoral prosthesis and new socket . Once again, I think your decision to proceed with THR is the most reasonable. The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. If your surgeon has recommended surgery, I assume youre no longer getting adequate relief of pain or able to remain active with conservative measures. It does sound as if proceeding with a THR is appropriate, since your attempt to repair the joint arthroscopically did not pan out. It's cut off and removed through the hole. According to Dr. Rosen, the most important thing to remember is what you leave behind rather than how you get there. Fortunately, you have already experienced a THR and have done well. I furniture surfed in the house and used a stick outside.I was hopeless with crutches, but I think it is recommended we should use them, particularly to ensure we don't get a limp and build our leg up properly. General comments will be answered in as timely a manner as possible, Hip & Knee Surgery Changes will take effect once you reload the page. I wish you well. During the procedure, the patient must have a small incision made in the side of his hip. This is because the nerve is located in front of the hip. In comparison to traditional methods, anterior approaches to the hip joint are more effective. No specifics were given to me from the orthopedist . Getting those studies will not change the reality that you will need THRs. With degenerative osteoarthritis of the hip developing secondary to a severe slipped capital femoral epiphysis (scfe), recreating normal hip mechanics after THR may have necessitated lengthening the first hip. One of the potential disadvantages is that because the surgery is performed through the front of the hip, there is a risk of damaging the hip joint and the surrounding muscles and tendons. I'm hoping to read some posts post surgery. and Privacy Policy and steps will be taken to remove posts identified The anterior approach, as opposed to the lateral or posterior approach, uses a small incision in the front of the hip. My recommendation is for you to discuss this with your surgeon if you have further concerns. Femor fracture. Risks of Hip Replacement Surgery The major risks include the following: Blood clot: We do reduce risk of this by using blood thinners (Enoxaparin, Aspirin or Coumadin), TED hose (compressive stockings) and compression boots on your feet to increase circulation. Very important with both the traditional posterior and the mini-posterior approaches, if the surgeon is not able to visualize critical structure adequately, or if a problem were to arise such as a fracture, then either approach can easily be adjusted. There does appear to be an increased incidence of stem instability when implanted through the anterior approach, but I believe this is largely a function of the surgeon experience. Pam. Why is that? This most often leaves the patient with an area of decreased or uncomfortable sensation or numbness over the anterolateral thigh (top, outside area of the thigh), not the entire thigh. http://holycrossleonecenter.com/blog/hip-resurfacing-or-total-hip-replacement-a-candid-discussion/, http://holycrossleonecenter.com/blog/metal-on-metal-hip-replacements/, I wish you the very best recovery. Every prosthetic joint has a mechanical range of motion. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. Unfortunately, short of conservative and supportive measures, only time will tell. Disadvantages of the anterior approach include: The nerve which supplies sensation to the front and side of the thigh is vulnerable. I'm hoping to read some posts post surgery. Should one of these events occur during a mini-posterior procedure, they are easier to recognize and correct. Felt very uninformed and left There is a chance that the hip will fall out of the socket, or that it will be levered out by twisting it. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. July 2013 my left hip was scoped for a labral repair. Also had I do participate in competitions and showcase presentations. When the stem is placed in the femur, it still destroys the same amount of bone for implantation, regardless of which approach is used. Other combinations of materials have advantages and disadvantages (for instance, some researchers believe that ceramic-on-ceramic types may be more durable, but they have also been known to make squeaking and popping sounds.) Is it really as good as it sounds? My two questions are: 1. Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. I would rather see my patients go home. Share your concerns with your surgeon. This improved quality of life will be beneficial. An anterior-approach hip replacement necessitates a small incision in the groin area on the front side of the leg. I don't think there's a one size fits all when it comes to hip surgery. What is SuperPath Hip Replacement? I encourage my patients to talk to other patients for whom Ive cared and learn about their experiences. The posterior approach for hip replacement surgery is by far the most common surgical technique used in the United States and throughout the world. Initially I was hesitant of THR thinking I was way too young for something so drastic but Ive now been miserable enough long enough that I am welcoming the idea of surgery. but it was more torn than they thought and they had to cut out about 1/4 of it. All: My question is, what will my restrictions be? There is no definitive answer to this question as different people will have different opinions and preferences. What are your thoughts with regard to Stem cell therapy in lieu of THR? If possible and a pool available, I encourage my patients to walk and exercise in a pool and / or swim, starting at two weeks when their suture is removed. All rights reserved. You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. DAA had a lower rate of hospitalization and functional rehabilitation as compared to the lateral approach, as well as a lower perceived level of pain. The most important thing is that tissue is handled gently and trauma is minimized, whichever approach is used. Hip replacement surgery can open up a world of possibilities for people who have lived with pain and restricted movement. It is difficult to get that from information which I find curious. Operating through too small an incision and not releasing tissue that would improve exposure and result in a more balanced joint in my opinion does a disservice. Can I expect any problems with the bilateral it was my choice. I emphasize continuing exercises at home especially walking. When done well, your body does well with this technology. Its been a nightmare for me going into 4 yrs post op soon. The doctor has scheduled me for total hip replacement in two weeks and he uses the Posterior approach, he didnt say anything about the mini part. There tends to be a lesser incidence of posterior instability with the anterior approach. It is important that you find a doctor who is experienced in caring for people with complex issues. While new techniques, instruments and prostheses have been developed specifically for minimally invasive surgeries, there are many well-established approaches to hip replacement. It is possible that you will be required to avoid certain high-impact activities to protect your new hip. [QxMD MEDLINE Link]. Can you compare/contrast to the other approaches; posterior, mini posterior, anterior? I would not recommend pushing your surgeon to use one specific approach or another. Did you have the surgery via Superpath method? Im getting close to needing my left hip done. People undergoing traditional hip replacement surgery, for example, are advised not to bend at the hip more than 90 degrees for approximately six weeks after the procedure. Excess weight causes a hip joint that has already been stressed to become more painful and disability-causing. The posterior approach is used by a small percentage of people. There are risks and recovery times associated with surgery. The surgeon does about 200 a year and people say he has a good reputation. If youre impressed by how clean it appears and the movement and professionalism of the staff, that obviously is a good sign.