It requires surgical insight and skill to accomplish. The Disadvantages Of Anterior Hip Replacement I thought the newer procedure on the special table was the best way to go. Blog Today, everything from tools to techniques has improved. The initial recovery period typically takes six weeks or more. Surgical Approaches in Total Hip Replacement Tina, which procedure did you have? What are the experiences of other countries with THR? hi im following as im due a superpath soon, there is no one size fits all everyones different I've had 2 hip replacements in 2 yrs one in 2017 then a revision to change the ball and socket to the smallest one they had and now I'm going for a smaller stem I had the anterior approch done which is in the front which is way better then the posterior as the front they can just move ur muscles over to the side to accsess ur hip rather then go through the back or side where they have to cut the muscles. Im hoping to play tennis, go dancing and horseback riding once Ive healed. I will let you in on something personal. Diagnosed possible labral tear. Clearly, yours was. Each surgeon approaches these issues individually. 2021 May 20;16(1):324 . Thank you for this! The nerve which supplies sensation to the front and side of the thigh is vulnerable. Many manufacturers are responding to the surgeons desire for shorter stems and many are now available on the market. A couple of things I am hoping you will explain using laymans termology. I'm hoping to read some posts post surgery. It is important that these medical and cardiac conditions be optimized by your PCP and cardiologist preoperatively. I was discharged within 24 hours. Patients who have this surgery no longer require walkers, canes, or other aids 5 to 7 days after the operation, in comparison to those who have hip surgery. How do you ask your doctor the questions you want to ask? Supercapsular Percutaneously-Assisted Total Hip surgery or SuperPATH surgery is a novel method of hip replacement where your surgeon can perform total hip replacement through 2-3 inch incision into the tip of the hip and without dislocating the hip or damaging the surrounding soft-tissue (muscles and tendons). 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. The surgeon I saw said that my body structure and gait does not affect which approach would be ideal for my body. Consult an orthopedic surgeon who specializes in hip replacement surgery if you have a hip problem. Losing weight and strengthening your muscles pre-operatively will make surgery easier and greatly facilitate your rehab. I was out of bed walking around the evening of the surgery . 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. General comments will be answered in as timely a manner as possible. Thank you for sharing. 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. Comments about life-long hip restrictions between Posterior, Anteriorlateral and Anterior approaches? Studying a hospital and physicians track record before you commit is important. Please comment. When a patient feels better, they can return to work almost immediately, though it usually takes two weeks or longer. I have had problems with my hip for the last several yrs. What are your thoughts on the use of robotics? Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? After reading your article on disadvantages of anterior approach and also doing extensive online search about this subject, I came to realize that anterior approach was definitely a wrong choice considering my physical build short, muscular, overweight. Egton Medical Information Systems Limited. Patient Concerns Depending on the degree of injury, you may need a knee brace to lock you knee in extension when walking until the quad function returns. I have congenital hip dysplasia which has gradually caused more pain as Ive gotten older. The main limitation after surgery is a lack of comfort. I would encourage you to discuss your expected recuperation time and specific restrictions with your surgeon. 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.) My husband, who is only 35, has to consider a THA in the near future and Im very torn over which approach as the surgeon we really like dos a posterior but I am concerned about dislocation rates in posterior vs anterior. Hip dysplasia is a very common underlying cause of hip osteoarthritis. Otherwise you will be prompted again when opening a new browser window or new a tab. The bone isn't dislocated in surgery. This allows you to resume normal daily activities quickly while also returning to normal range of motion and function. Six months ago I had a right posterior THR due to severe scfe; now my right leg is 5/8 longer than my left leg. My problem isnt from a worn-down joint with no cartilage. I dont want a long recovery time as I am very active. It is nice to see honest Q&A versus a marketing page. I have been in excruiting pain and unable to do everyday normal activities. That's all I know. The most important thing is that tissue is handled gently and trauma is minimized, whichever approach is used. If a patient has abnormal anatomy (such as dysplasia, posttraumatic arthritis, or morbid obesity), or if their body mass index is higher than 35, it may be impossible for them to be considered for direct anterior surgery. If you feel confident in your surgeon, I would discuss it frankly follow his or her guidance as to which approach and prosthesis are most appropriate to give you the best result. I went in with high expectations of coming out so much better off and here I am 5 yrs out limping more than ever and a NUMB thigh and worse knee and weak ankle. I dont know what type of procedure was used for my first op but it was sucessful and now can do a half lotus position with no problem.I do find however that the muscles at the front of that leg are not as strong as my unoperated right leg and lifting the left leg to a vertical position in yoga, when lying on my back, is quite difficult. I am planning to have a THR this summer. Dr. Leone, I am coming in to see you for an appointment for a THR to my left hip. 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. Thank you, 1000 NE 56th Street, Fortunately, if the components are stable (bone-in grown or cemented) and optimally positioned, and the surrounding tissues has fully healed and matured, then that risk is very small. Possible Infections Dr. Sutphen: A minimal number of surgery patients (roughly around 1%) can develop an infection around their hip replacement. Conserves the two main muscles that make up the front of the hip and upper thigh aspirated via the direct anterior approach. The anterior approach is not as muscle sparing as some would argue. Im so pleased to learn that you had a good experience. The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior https://holycrossleonecenter.com/wp-content/uploads/2018/12/Screen-Shot-2018-12-10-at-3.48.24-PM.png, https://holycrossleonecenter.com///wp-content/uploads/2017/11/Leone-Center-Logo@2x.png, The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior and Direct Anterior, Copyright 2018 - 2023 The Leone Center for Orthopedic Care. Does the mini posterior hip replacement conserve more femur and allow for future surgeries if needed ? I had an anterior approach hip replacement. Overall, it sounds as if youve had an excellent result and wonderful recovery following your hip replacement. Woke up with The SUPERPATH hip replacement is a new technique using superior capsulotomy that allows for implantation of the total hip components under direct vision through a single incision. Thank you for this great informative discussion. THR - Posterior or Superpath Decision - Joint Replacement Patient Forum Your blog on anterior vs posterior approach was very informative. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. Your article lacks the pros of the AMIS and the cons of min invasive posterior. Fort Lauderdale, FL 33334 How long will my hip replacement last? So im going back to the surgeon that did my left hip and left me in agonizing pain for 2 months after procedure. Hospitsl staff Just because hardware in your foot needed to be removed after repairing what sounds like a calcaneal (heel) fracture, absolutely does not mean that your body rejected the metal / hardware or that your body will reject the prosthesis your surgeon will implant to reconstruct your hip. The surgeon will be building a construct that hopefully will last her life time and change her life profoundly. Dear Dr. Leone, An anterior hip replacement procedure, on the other hand, performs the same function as an anterior hip replacement in terms of tissue shaving. Posted What is your experience and take on this ? Ive come to the conclusion that perceived benefits do not outweigh the risks with the anterior approach, especially when I can achieve the same or more using the mini-posterior. When it comes to revision surgery, we rely heavily on the posterior approach. Some in the early period have good track records, others do not. daniel neeleman net worth . Your frustration is completely understandable. An anterior hip replacement does not have any limitations based on comfort. Most receive a simple spinal with sedation. Other jobs, which tend to be more structured and / or more physical, may require more time off. Comparison of short-term outcomes between SuperPATH approach and I absolutely would not insist on minimally invasive surgery and a small incision, especially considering your mom is short, obese and has osteoporosis. What is most important is that the surgery is expertly done, that the tissues are not brutalized, and that the surgeon can see what he or she is doing. Changes will take effect once you reload the page. It is critical that the patient is aware of the risks, benefits, and alternatives of the procedure. I think its always beneficial to speak to other patients who have been cared for by that physician and learn about their experiences and results. Mayo Clinic researchers have studied ways to reduce blood loss, control pain and speed recovery for people who undergo hip replacement surgery. No one tells me the same thing? Most activities of daily living have an element of hip flexion (knee up to head), which is a safe position after the anterior total hip. I would anticipate that you would be able to return fully to your activity once the tissues around your total hip heel. What Is Superpath Hip Replacement - HipsAdvice.com Specific protocols, therapy and what positions you will be asked to avoid after surgery and for how long will be directed by your surgeon. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. A mini posterior approach is a modification of the classical posterior approach. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. My gait is off partially due to my hip but also I believe because of my body structure. Hip Preservation Surgery | Duke Health Posterior or Anterior? It is difficult to get that from information which I find curious. Dr. William Leone. A hospital outpatient surgery can cost between one-third and one-half the cost of an outpatient surgery atCOSC. They may have a certain cut-off criteria (for example, a BMI of less than 35). Posterior, mini posterior or anterior? If this occurs, the patient may experience pain and swelling. I live in the UK so again Im afraid I wont be able to consult you personally! We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. What are your thoughts with regard to Stem cell therapy in lieu of THR? During the procedure, the patient must have a small incision made in the side of his hip. SuperPATH hip replacement Pros and Cons - Thoracentesis I feel that at 10 weeks with profuse denervation potentials on the quad muscles, the prognosis is not good, even at 6 months. What is most important is choosing your surgeon. 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. Both problems are on the right side of my body. Share your concerns with your surgeon. Currently, the incidence of dislocation after the posterior approach has been greatly reduced due to technique and other refinements. I ride horses, water ski and kayak. Fitness going into surgery and speed of recovery seems to be a common theme though. 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. Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. What do you consider to be the most important factors in choosing a surgeon? Finally, because my patients are walking the day of surgery, most want to go home rather than to rehab. I just saw a patient with a femoral neuropraxia after a anterior approach THR. Im ready to have the surgery, having been basically bone on bone for several years. Thank you, Rita. Further, the extent of dissection is more minimally invasive, which also improves stability. I think the recovery time is the same though. Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. I am wondering if having mild hip dysplasia is a factor in which approach is used. Ultimately, you and your surgeon should discuss all procedures and technologies available and then trust that your surgeon will choose the best course of treatment and surgical procedure for you. J. Dear Dr. Leone, The leg lifts really aggravate the front of the hip. We have to get ok from cardiologist and get ekg, chest xray, etc. I would not anticipate them improving with time, but rather worsening, and I cant imagine you being able to resume the activities you described without having surgery to treat this. 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. I have been told that I can fly 48 hours after surgery?? The hope is that your nerve injury will recover with time. I dont think there is one best prosthetic. Some have features that are more suited to one persons anatomy and needs than others. I would say that in terms of posterior total hip replacement, the procedure is better than the old gold standard, which I believe was performed after 7 years and almost 1000 anterior total hips. I am about to have a hip replacement and would like to know what kind of limitations Ill have afterward. It turned out to be more torn than they thought and they had to cut about a forth of it out. You should feel good that you are aware of your fears and that it hasnt paralyzed you into not acting. I have cared for many patients over the years with significant heart and peripheral vascular disease. Long-term outcomes of SuperPATH approach need to be investigated. Disadvantages of the anterior approach include: The nerve which supplies sensation to the front and side of the thigh is vulnerable. Does this mean my body may reject the metal of the post or cup? Ken. Some patients report that symptoms increase in the not-yet reconstructed hip because of the leg length inequality. Because the patient is lying on his back, it facilitates using a fluoroscope or moving x-ray throughout the procedure. As a result, patients can return to their normal activities much sooner than if they had had traditional hip replacement surgery. SUPERPATH Hip Replacement | Bethesda Orthopaedic Institute Having a THR is a major undertaking and it is reasonable to expect the hip construct to function optimally for twenty and more years. I wish you a full and uneventful recovery. I am concerned that I may have a pinched nerve and that that is what is causing all this pai as the pain is severe only in certain positions but when I am tired I also have a throbbing pain in the sciatic region.talk about the golden yearsI thank you from the bottom of my heart for the kindness and caring that you do in answering all these questions. With the ease of movements during pregnancy, you will be able to move around more freely. I believe a THR will benefit you tremendously. I wish you well. Cons of Robotic Assisted Surgery As with any type of procedure, Mako is not without its drawbacks. I prefer reconstructing the most symptomatic side first. Contact Dr. Moor, Orthopedic Surgeon at Advanced Sports Medicine Center. Because the anterior hip replacement surgery is a minimally invasive procedure, no cuts are made to the muscles surrounding the hip. I believe this is an important discussion you should have with your surgeon preoperatively. Download scientific diagram | (a) Components of a total hip replacement; (b) The components merged into an implant; (c) The implant as it fits into the hip [15]. As a result of this precaution, it is difficult to sit on low chairs, sofas, or toilets. It allows the surgeon to work between the muscles and tendons without removing them from their anchoring points on the hip or thighbone. Imagine your femoral head lacking full acetabular coverage, resulting in an overloading of the superior aspect of your socket, hence the cartilage and labrum becoming damaged and ultimately breaking down. It typically requires a 4 to 5 day hospital stay, 3 to 6 month recovery period . If possible, choose a hospital that specializes in joint replacement and can back that up with excellent statistics and reputation. I would discuss fully your goals and concerns. How long will my hip replacement last in your opinion? This improved quality of life will be beneficial. Anterior hip replacement has the potential to cause complications and pose some risks. That being said, in order to meet your goals, if need to leave your area and consult with surgeons in other areas, I think that is reasonable also. When it comes to hip replacement surgery, the surgeons skill, the patients weight and build, and the surgeons level of experience all have an impact. Very sorry to hear of the difficulties you experienced! I have been in pain for about a year and first though it was a back issue and it has limited my ability to stay as active as I would like. I began using the superior approach for total hip replacement in February of 2014. . In comparison to traditional methods, anterior approaches to the hip joint are more effective. The bigger the ball, the bigger the ROM without impingement and the bigger the jumping distance that would be required for the hip to dislocate. In the United States, a traditional posterior approach is the most commonly used. What do you mean by painful anterior scarring and soft tissue exposure and trauma? Over time, untreated hip dysplasia or hip impingement can lead to arthritis and, eventually, hip replacement surgery. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. 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. We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website. Choosing a surgeon should be based on published data (if available), as well as his or her reputation in the community, according to Dr. Delcore. The pain in my hip is strange in that I can hike uphill and down hill, bike and X-country ski but have a very hard time walking on the flat, especially after sitting for awhile or getting out of bed. It is so important to stay focused on the outcome of your hip replacement surgery: excellent results both short- and long-term with minimal risk of injury or complication, and not lose sight of the real goal, which is to create a perfectly positioned reconstructed hip that is stable, balanced and has the best possible chance of lasting more than twenty years. Seeing that a THR is considered major surgery, my question is, should I have my left hip done sooner than later to address the length difference or wait until I can no longer tolerate the pain? A lot of hospitals and ambulatory surgical centers offer what's called outpatient surgery. The mini-posterior is considered a more straightforward approach then the anterior, resulting in lesser complication rates. I would encourage you to discuss your concerns with you surgeon. Most of the restrictions are removed at that time, although I still advise common sense, particularly for the first three or four months. In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. If your surgeon did a great job, that is something to respect. Technologies, The Leone Center thank you for your time. The incision made for the operation can be as small as three inches. The Hanna bed, general anesthesia machines, spinal setup, medications, ventilation, instruments, and their sterilization are all prerequisite. On July 17th, I had a left THR. Dear Dr. Leone, I am having Makoplasty ( robotic imaging) to my right hip in February. Patients can also have as little as a 3-inch incision. Finally, in July 2013, the first SuperPATH Hip replacement in Australia was performed in Nepean Private Hospital, Sydney. SUPERPATH Hip Replacement Surgery - Health Pages Can you compare/contrast to the other approaches; posterior, mini posterior, anterior? Thank you for sharing with others the nerve supplements that youre finding affective. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. Although, personally I would feel strongly about reconstructing the hip through the mini posterior approach (there tends to be considerably less bleeding with this approach), other very caring and competent surgeons might feel just as strongly about using a different approach. 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). Since 1995, there has been an extremely low dislocation rate and an infection rate of zero percent. The first step to rule out infection is to have two simple blood studies done, an ESR and CRP. Why would the doctor not have that at their finger tips? Also, since I am only 51, I am concerned about component longevity. The new femoral prosthesis and new socket . Some patients who have recently had anterior hip replacement may suffer from complications such as wound healing. Less tissue damage during surgery allows for a much faster recovery and no restrictions in range of motion when compared to traditional hip surgery. Your back does need to be evaluated as well. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. Ann Transl Med. Im 51, 59 and 148 and want to get back to tennis etc, this has been long frustrating process. There is no definitive answer to this question as different people will have different opinions and preferences. Have you recovered by now? I have been doing ALOT of research about the different approaches to THR and looking for the absolute best surgeon. surgeons certainly do not go out of their way to cut anything, they move stuff about, if tendons do get damaged, it's more likely from the anterior approach as they have less 'sight' of the procedure due to the smaller incision. How Much Does Minimally Invasive And Robotic Hip Replacement Surgery Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. I am female and I weigh 115 pounds. I think it perfectly ok to discuss different approaches and ask for an opinion. Hip Replacement | Rush System Hip anatomy The mini posterior approach essentially is the same as the traditional posterior, however a smaller incision is made and less soft tissue is exposed. Even a task as simple as putting on socks and shoes can result in debilitating discomfort when a severely damaged or arthritic hip is involved. Both have valid cons against the others methods and pros on their method. The source of your hip pain must be diagnosed. All orthopaedic surgery demands a long recovery period. But after reading your articles, I am hesitant about that choice now. You can also change some of your preferences. A neurologic evaluation is appropriate to rule out reversible causes, but most work-ups do not elicit the exact etiology and usually symptoms only can be managed at best. Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer. I suspect there is significant underlying osteoarthritis related to your labral pathology. There are a few complications that can occur with anterior hip replacement surgery. But I feel that time could be lost and all my symptoms may become irreversible. My advice is to focus on finding a surgeon with whom you are comfortable and have the best chance of doing well. 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