There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. The actual length of the incision really is not important, but rather how well the components were implanted and the hip mechanics restored. Please do not take this as an attack, but your article seems biased on your experience (great results with min. The surgeon does about 200 a year and people say he has a good reputation. 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. There is a chance that the hip will fall out of the socket, or that it will be levered out by twisting it. Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis.Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Many, many interactions and decisions go into the final result as well as someones perception of his or her result and experience. After reading your article I am concerned about the issues you discussed. Its been my experience that patients who go into surgery well informed have a better experience and seem to rehabilitate more quickly. Should one of these events occur during a mini-posterior procedure, they are easier to recognize and correct. There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. I'm hoping to read some posts post surgery. Above the ankle to the thigh.Had to use leg brace to Nerve regeneration can occur up to 18 months following injury, but the chance of full recovery decreases with delay in recovery time. I am a competitive tennis player in my age division. Ive never foulnd information from any doctor or research-site but that there is always no legs-crossing, no more than 90-degrees (for the most part), and no twisting for anything but full Anterior. I was discharged within 24 hours. There are several positions to avoid after anterior hip replacement, as they can put unnecessary stress on the new hip joint and lead to dislocation. Also there are concerns about disruption of blood supply to femoral head with this operation. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. This treatment is commonly recommended for patients suffering from osteoarthritis of the hip. Even if the hip doesnt dislocate, prosthetic or soft tissue impingement is not beneficial. Its from a malformation. Have you ever performed the Mini on a patient 1 year after major open heart surgery? When people loose independence and mobility, not only does the quality of life suffer, they are much more likely to develop a myriad of medical problems requiring even more-expensive and/or long-term care, including loss of independent living. Testimonials I have read your articles about procedures (anterior vs posterior). more nutritious, too. Advantages of this procedure include: The direct anterior approach involves dissecting between the natural intervals of the two main muscles located at the front of the hip and upper thigh. Lastly, if one has had P or AL is there anything that can be done to offset the need for restricitons? No Muscles Cut is for billboards. It is highly recommended that you avoid bending your hips and turning your feet together as part of hip precautions. I think its reasonable to request a tour of the facility where youre considering having the procedure. It's what compelled me to seek out different methods and post here.. You will find the surgeons will all give the pros but never the cons what ever the method. But after reading your articles, I am hesitant about that choice now. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. 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 is his perspective based on careful observation of outcomes. Any info would be appreciated. Hip dysplasia is a very common underlying cause of hip osteoarthritis. Would appreciate any input you might have on the auto immune issue, and weight etc. I assume PTHR is referring to partial hip replacement. If this occurs, the patient usually requires a total hip replacement. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. My first bike ride was 22 miles without any problems. If you have these arthritis symptoms, you should consider a hip replacement: severe hip pain that is not relieved by medication and that interferes with your work, sleep or everyday activity hip stiffness that restricts motion and makes it difficult to walk To learn more, read Here's What to Know if You Think You Need a Hip Replacement. Its interesting that when we critically analyze all the variables that ultimately make up the experience that one person has compared with another, or that one person experiences on one side versus the other, we come to recognize its not so straightforward. Most patients decide not to wait as long to have their contralateral hips or knees replaced after having undergone a successful surgery on the first side. The hope is that these new designs will, but time will tell. I already have an artificial knee that is doing great. Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. There are many different quality implants (just like surgeons and hospitals). That I knew this recovery may take 1-2 Are these expectations realistic? Your out-of-pocket costs for your hipreplacement will be impacted by a number of . My surgeon wants to use the posterior approach and indicates that I eventually should be able to play golf again. Therapy hopefully will help any contractures and scaring within your muscles that might have developed after surgery. Because of the marked improvement in modern plastics, there is greater longevity and durability of acetabular plastic liners and larger femoral heads are used routinely which results in an improved the head/neck ratio and therefore the jumping distance for a hip to dislocate. What, if anything, can be done to revive femoral nerve and get my thigh muscles back in normal? Patients who are significantly overweight (I specifically assess the amount of tissue between the skin overlying the lateral hip and the greater trochanter), who have significant long-standing contractures and restricted ROM, congenital dislocation, and marked acetabular protrusion (when the femoral head wears centrally into the acetabulum) typically require a larger incision and more soft tissue releases. Individual results and activity levels after surgery vary and depend on many factors including age, weight and prior activity level. Orthop Clin North Am. The art of surgery should mimic a well rehearsed ballet or symphony. Because the femur is more difficult to expose during the anterior approach vs. the posterior approach, many surgeons will select a shorter femoral component to facilitate reconstruction and lessen chance of fracture. as being in breach of those terms. As for doctors, the surgeon I had came highly recommended. Very strange No groin pain NOW.but all the other mess of it all. Your frustration is completely understandable. In another day I was able to take short walks without any limping, etc.. After reading your article I see there are many reasons to go with the posterior approach but nothing about having to use a smaller prosthesis with the anterior approach. (I have SCD) It has now become unbearable and I am preparing for surgery. I dont think there is one best prosthetic. Some have features that are more suited to one persons anatomy and needs than others. Also on MRI there was a cyst (good size). Dr. Tom Miller gives you the five best options for hip replacement surgery. My doc said the angle of my hips is not the worst but also not the best. I definitely would not recommend a hip scope and THR during one anesthetic setting. I am very athletic and active even with many years of pain from bone on bone arthritis so I am worried about restrictions since Ill probably forget or something. United States. In general, if someone is dedicated to the job, the return is very quick. The femur is prepared with the head and neck intact reducing the chance of fracture. for Orthopedic Care I take care of many individuals who have a total knee and hip replacements on the same side. Super path appears to come with it's hazards due to bone sawing rather than dislocation of the hip to be replaced, making revision much more difficult if issues occur later down the line. In Dr. Lawrence Dorrs opinion, doctors and hospitals should not market a specific type of surgery as the most effective. In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. 2021 May 20;16(1):324 . My gait is off partially due to my hip but also I believe because of my body structure. Third, the procedure is shorter in length and requires less hospital stay than traditional hip replacement surgery. I was initially sent to a surgeon to consider repair but he said my chances of being happy with the outcome were only 30% and suggest a THR. Remember, what youre hoping to do is have a hip construct that will last 20 years or more. If possible, choose a hospital that specializes in joint replacement and can back that up with excellent statistics and reputation. Mine certainly have. Driving hurts too. Others continue to follow traditional guidelines. 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. . The posterior approach is used frequently again, in large part due to the fact that it is an extensile approach. I would like to share my experience with both procedures. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. 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 also would learn about the track record of the surgeon and hospital where you will decide to have the surgery and what implant will be used. The posterior approach for hip replacement surgery is by far the most common surgical technique used in the United States and throughout the world. I have the surgery planned, but then another medical professional warned me that the posterior approach will limit my twisting range of motion and prevent me from playing golf. Yes, you do have increase risks. I believe a THR will benefit you tremendously. There are a few disadvantages of anterior hip replacement that patients should be aware of before undergoing the surgery. Very slow recovery. I had the posterior approach, the surgeon did not cut any muscle plus I had no pain at all after the op. I have many patients who are accomplished and passionate ballroom dancers. 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. My doctor does the Posterior approach, he didnt say anything about the mini part. Since these providers may collect personal data like your IP address we allow you to block them here. One advantage the ceramic-on-polyethylene carries is the lack of . Each approach has advantages and disadvantages. The hip joint needs to be replaced again when it no longer works properly because of a revision surgery. An anterior hip replacement procedure, on the other hand, performs the same function as an anterior hip replacement in terms of tissue shaving. Fewer narcotic medications are administered, resulting in a better overall recovery. Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. There always are conditions or circumstances that may predispose one to limp or feel as if their legs are not the same length after surgery, but in my experience this is the exception. Publications We have an appointment today to discuss the plan of action. 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. Can You Use An Inversion Table With A Hip Replacement I had the mini posterior approach done and it gets better everyday. Each approach you list has advantages and disadvantages. Typically, the new cup will be medialized to gain coverage and correct the abnormality that lead to your arthritis. I ride horses, water ski and kayak. My two questions are: 1. My advice is to consult with your surgeon regarding how stable the replaced hip is and the most appropriate rehab to follow post-operatively. [QxMD MEDLINE Link]. He treats a variety of hip, knee, and shoulder conditions, and performs hip and knee total joint replacements. I dont know if this stems from the knee surgery but I do not believe so because I was well for about a year and a half. Superpath total hip replacement animation. I share your concern that with profuse denervation potentials 10 weeks post injury, that the patient may have sustained a more severe injury than a neuropraxia. There is also a small risk of infection at the surgical site. After the direct anterior approach, there is generally no hip precautions required, and motion is not restricted. It seems reasonable and I trust my surgeon but would like to know what I'm in for post op and beyond. My advice is to have a frank discussion with your surgeon and share these concerns. Once it exceeds this ROM, impingement occurs. I would discuss fully your goals and concerns. I wish you only the best, What are the risks involved? Risks of SUPERPATH hip replacement surgery Risks due to the surgery may include (but are not limited to): Pain Bleeding Infection Permanent or temporary nerve damage Extra bone or tissue damage Drop in blood pressure during the procedure Leg deformity Blood clot or clots (that could travel to heart or lungs) Delayed wound healing #1. The surgeon was not at the pre-op meeting, but the PA assured me it was not that big of a deal (but to me, ALL surgery is a big deal!). The mini posterior approach works wonderfully and predictably when expertly performed. Infection. I am allergic to narcotics . Posterior or Anterior? Surgical Techniques It also helps to stabilize the acetabular shell and prevent soft tissue irritation on the out edge of the cup. not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in Posterior, mini posterior or anterior? Can you explain it to me as he didnt go into detail. As a result of the interventions, the surgeon has a better view of the hip joint. I have been in excruiting pain and unable to do everyday normal activities. This too will lower your anxiety and improve your experience. 10 users are following. July played my last match when I buckled. Thigh feels so Heavy and I massage that area a lot. 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. In 2010, more than 310,000 hip replacements were performed in the United States. I was out of bed walking around the evening of the surgery . I would stay away from narcotics. I am deciding that my quality of life is in the toilet and need to get the THR done. I would focus on the individual doctor, not the approach that the individual choses to use, to deliver the best result. Nobody wanted to talk Some surgeons believe that a patient who is neither obese nor overly muscular is a good candidate for anterior hip replacement surgery. 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. It is critical to make the right decision regarding anterior hip replacement surgery in each case. 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. So im going back to the surgeon that did my left hip and left me in agonizing pain for 2 months after procedure. SuperPATH showed better results in decreasing operation time, incision length, intraoperative blood loss, and early pain intensity. Patients mobilize the day of surgery and typically go home the next day. Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. It exploits the inter-muscular interval between the tensor fascia lata and the gluteus medius. The anterior approach, as opposed to the lateral or posterior approach, uses a small incision in the front of the hip. The traditional posterior approach is the most commonly used in the United States and throughout the world (about 70 percent). There are a number of different surgical ways (approaches) to access the hip joint. Thru X-rays Ive been told both hips are bone on bone! This does not necessarily mean they will have more pain or take longer to get well. The bone isn't dislocated in surgery. Its been a nightmare for me going into 4 yrs post op soon. Surgical approach is important but its just one of many important variables. Thanks! An artificial joint is used to replace the worn out hip joint during a hip replacement procedure known as posterior hip replacement. 2023 Brandon Orthopedics | All Right Reserved, hip replacement pain reduction surgery patients, The Best Sneakers For Hip Replacement Patients, Anterior Hip Replacement Surgery: The Pros And Cons, The Truth About Spinal Stenosis: Causes Symptoms And Treatments, Can Years Of Surfing Contribute To Spinal Stenosis, The Effects Of Spinal Stenosis And Carpal Tunnel, Should I Apply Ice Or Heat To A Compression Fracture, How Does A Soft Bed Prevent Healing Of Herniated Disc, Herniated Discs: How To Sleep Without Worrying About Rupturing Your Discs, If You Have A Herniated Disc You Know The Excruciating Pain It Can Cause. Regardless, the overall incidence of dislocation for every approach is smaller due to use of larger femoral heads and enhanced closure techniques. It seems, however, that at this time point, patients who have received resurfacings do as well or better than similar patients who have received total hip replacements. Dr. Leone, I am coming in to see you for an appointment for a THR to my left hip. Hip replacement surgery can open up a world of possibilities for people who have lived with pain and restricted movement. I had posterior and much like the superpath trussed into the jig . Woke up with Very few metal-on-metal bearings are being placed today due to the serious potential of metallosis. This suggests that something changed after five months. Clearly, yours was. Surgical Approaches To Hip Joint Dr. Apoorv Jain D'Ortho, DNB Ortho . How does it affect the actual success of the This treatment is much more definitive and predictable. Would you recommend treating plantar 1st? This means you could go home within 23 hours after surgery. I needed no physical therapy at all. Sitting seems to irritate it the most. Upgrade to Patient Pro Medical Professional? Historically, higher dislocation rates were reported with the posterior approach, but it still was used for its many other advantages. It requires surgical insight and skill to accomplish. The only problem Ive had post hip replacement is some on/off again groin pain. I have since read that hips with this condition might get worse after labrum repair due to this structural defect. This improved quality of life will be beneficial. Introduction Hospitsl staff 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 was thinking of a Hip Resurfacing for my left hip and was convinced by my other top hip surgeons to stay away from it. Also, I am diabetic and have had two organ transplants and am extremely worried about infections, etc. My clinical impression is that more patients experience some degree of residual groin discomfort or tightness after the anterior approach as compared to the posterior approach, but that it tends to resolve with time. Since a significant amount labrum has been removed, I think another attempt at arthroscopy would prove very disappointing and I would not recommend it. It is important that these medical and cardiac conditions be optimized by your PCP and cardiologist preoperatively. Many wonderful physicians are part of various HMO panels. There is less risk of neurological injury. A shorter hospital stay and faster recovery are typical of this because there is less damage to the muscles. Dr. William Leone. 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. So my question is in relation to my body structure. 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)? I would encourage you to discuss with your surgeon the difficulties and pain you experienced after the first surgery, and together explore if another plan can be created for a better outcome the second time around. Also, because technically it is easier, many patients are being reconstructed with very short stems which are press fit into the bone during an anterior approach. Had arthroscopy in Jan 15, cleaned up tear and arthritis. I began using the superior approach for total hip replacement in February of 2014. . Hip replacement is the second most common type of joint replacement, trailing only total knee replacement. Lift your knee rather than your hip at the same time. Some patients who have recently had anterior hip replacement may suffer from complications such as wound healing. It is important that the individual who ultimately implants your next THR uses the approach which he or she feels comfortable with and has the best chance to deliver the optimal result. My question is: should I just tolerate the pain and limp, or take a chance with the hip replacement. If your surgeon cant answer your questions about hip replacement or provides unsatisfactory answers, you may need to consult another surgeon. Thank you so much for your answer, I appreciate your taking the time to care about others. If I can put you on the spot. Please comment. Following surgery, the surgeon will devise a routine for the patient to engage in that is both comfortable and safe. SuperPath hip approach. The socket of the pelvis is machined into a hemisphere and a metal hemisphere is inserted into the socket. Once again, it sounds as if you had a wonderful surgeon, which is the most important variable. Before proceeding, it is a good idea to review the recommendations and specific parts that your surgeon may recommend. It is important to consider the SuperpathTM technique if you are considering a hip replacement. Currently, the incidence of dislocation after the posterior approach has been greatly reduced due to technique and other refinements. Potentially there also is less pain and a quicker recovery. He is the founder and main author of brandonorthopedics.com, a website that offers valuable resources, tips, and advice for patients looking to learn more about orthopedic treatments and physiotherapy.