Disadvantages of the anterior approach include: Although I am trained in both approaches and have trained surgeons in both approaches, I have stopped using the anterior approach because I saw my patients get well faster, bleed less, and have a more predictable result when I performed the surgery using a mini-posterior approach. They may be: Cemented to the bone. However, I now have quite severe OA in my right hip apparently I have no cartilage left and have been told by a surgeon that I am just lucky not to be in constant pain. I have a tilted sacrum, sway back and a very large posterior. Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. No, I would not tolerate the pain and immobility, if there is a reasonable way to relieve it. Is it really as good as it sounds? Select a surgeon based on your impression of that individual: how engaged was he or she in your care, will you have access to that person as well as his or her team before and after surgery? What has changed the most in my career, once again in a very positive way, is how quickly patients start walking (day of surgery), and go home and return to their active lives after THR, as compared with just a few years ago. When we quote probability of longevity after hip replacement based on following people who had the operation, it is based on standard length stems. Potentially there also is less pain and a quicker recovery. More likely, its because ones activity increases after the first THR. Of note, I am a RN with 30 years of experience and took this decision very seriously. Dear Mary, It is generally agreed that the temporary numbness is more than balanced out by the substantially improved recovery, reduced pain, absence of a limp, faster return to function, and virtual elimination of the risk of hip dislocation. Any info would be appreciated. While new techniques, instruments and prostheses have been developed specifically for minimally invasive surgeries, there are many well-established approaches to hip replacement. The most common total hip replacement method is the anterior approach, which allows the surgeon to see better, more precisely place implants, and perform less invasive total hip replacement surgeries. 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. It's a hip replacement surgery where you lie on your side. Posted Potential Disadvantages of Anterior Hip Replacement Anterior hip replacement does have a few limitations: There may be wound healing issues Research suggests that people who undergo anterior hip replacement may be more likely to have a problem with wound healing, particularly infection. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. Obese or extremely muscular people may not be the best candidates for this surgical procedure. Your blog on anterior vs posterior approach was very informative. There tends to be a lesser incidence of posterior instability with the anterior approach. Because I have scfe also in my left hip, I will have to have it fixed too. 2004 Apr. All of these releases may be necessary as part of the surgery and patients do well. On the other hand, there may be a slightly increased incidence of anterior instability. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. Every patient needs to have as limited an approach and dissection as possible that does not compromise the final implant position or create excessive trauma to the soft tissues. Is the hospital where the surgery will be performed also top rated?. During the procedure, the patient must have a small incision made in the side of his hip. These can include damage to blood vessels or nerves, dislocation of the hip, and infection. I wish you the best of luck with your care. This risk is greatest in older females with bone of sub-optimal quality. I have congenital hip dysplasia which has gradually caused more pain as Ive gotten older. Ultimately, it is important to discuss all of the available options with your doctor to determine which method of hip replacement is best for you. There is also a small risk of death associated with any surgery. We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. Following anterior hip replacement surgery, avoid soaking in hot tub, sauna, or swimming pool immediately after surgery. Im hearing no restrictions (once recovery is done) for Anterior, but always some for the other two. It is not a substitute for excellent surgery. Its been six months since surgery, my operating doctor keeps feeding me with lets wait another month stuff. I had the mini posterior approach done and it gets better everyday. Very sorry to hear of the difficulties you experienced! Do you also do arthroscope surgery? I, too, am struggling which approach to have. 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. Between your legs, you should sleep with a pillow for the next six weeks. Dr. William Leone. How does it affect the actual success of the It requires surgical insight and skill to accomplish. The bone isn't dislocated in surgery. 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 would also like to know about the customized implant, as I havent yet heard much about it. Just getting your thoughts I will discuss it more with my surgeon at the pre-op meeting. Which approach did the doctor take? OTC nerve supplements suggested by a naturopath. I am experiencing pai. Apples to apples which procedure has the lowest incident of complications? If so, is it possible to have both hips done at the same time? Intervals between muscles are separated or muscles are separated in line with their fibers without injuring the muscles innervation. Nobody wanted to talk Hip replacement via SuperPATH approach had a longer operation time than hip replacement via conventional approaches. Conserves the two main muscles that make up the front of the hip and upper thigh aspirated via the direct anterior approach. We need 2 cookies to store this setting. You are free to opt out any time or opt in for other cookies to get a better experience. J Bone Joint Surg Am. Why is that? There are many factors that contribute to whether or not someone is a good candidate for anterior hip replacement surgery. I spoke to the surgeon, he believes it may take up to 6 months to get better from this neuropraxia. Sometimes during surgery it is necessary to release particularly tight structures to expose the joint for reconstruction or to better balance surrounding soft tissues after reconstruction. Get Directions, Phone: 954-489-4575 Many in business or who own their own businesses will stay home for only one week and then return to their work place because they are bored and would rather be productive and busy. Do I have a high percentage of hip dislocation after a 2nd revision done posterior way if so what is my chance of another hip dislocation even if I do the surgery again? In the front of the hip, fewer muscles are present, so the surgeon works between them instead of cutting through them and then detaching them (and then repairing them after the surgery). The hip is replaced without the need for surgery to dislocate the joint. No one tells me the same thing? It is possible that you will be required to avoid certain high-impact activities to protect your new hip. A femoral nerve injury is devastating and is more vulnerable during an anterior approach than with other approaches. Infection. Most doctors have and continue to implant hips through the posterior approach. It is also possible to have an anterior hip replacement during pregnancy. 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. 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. An anterior-approach hip replacement necessitates a small incision in the groin area on the front side of the leg. I am female and I weigh 115 pounds. The most common type of total hip replacement is done in the anterior anterior part of the hip. The surgical area of anterior hip replacement is located in the vicinity of the lateral cutaneous femoral nerve. I deal with OA lower back mess so know I see most likely how all this has played into the surgery. I have had problems with my hip for the last several yrs. If, on the other hand, the leg length difference is creating hardship and possibly discomfort in other joints such as the lower back, knee or ankle, I would consider proceeding with contralateral THR sooner rather than later. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. I really appreciate this website. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. My doctor does not do mini posterior, therefor I have a 6 incision. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. There are a few complications that can occur with anterior hip replacement surgery. When studying the hospital credentials, try and learn how many joint replacements are performed at that hospital each year, their infection rate and their 30-day readmission rate. I can still do 30-45 mile rides, but I need to take something before each ride, because of the undone left hip. Lastly, if one has had P or AL is there anything that can be done to offset the need for restricitons? 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. What are the experiences of other countries with THR? The majority of teaching institutions in the United States continue to instruct as well as perform the traditional posterior as their primary approach. I dont want a long recovery time as I am very active. Every prosthetic joint has a mechanical range of motion. Your article is the first Ive read in which no muscle or tendons are cut in any approach other than the direct anterior approach. The hope is that your nerve injury will recover with time. I actually was supposed to get both done at roughly same time but its been 3yrs with this bad right hip, mainly i was in great fear of going through that pain again, but now i think that pain will be better than this everyday pain!! Im considering this mini posterior approach. Thank you for all you do and for providing me with the information when I needed it. If your X-rays reveal that you already have bone on bone due to osteoarthritis, then you typically dont need either an MRI or Pet Scan, unless another diagnosis is suspected. I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. Anterior hip replacement is a type of hip replacement surgery. Does it really not matter which approach I have, posterior or anterior? Thank you for sharing. Studying a hospital and physicians track record before you commit is important. as being in breach of those terms. It is 100 percent normal and expected to be scared before surgery. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. Dr Leone, you make the point several times that the surgeon, not the procedure is most important. Im sorry to learn that you are so disappointed with your hip replacement. One of the biggest changes that Ive seen in my practice over the past 25 years is how quickly patients get well and go home. The anterior approach typically does not violate this structure. If they are really happy, then you probably will be as well. It seems reasonable and I trust my surgeon but would like to know what I'm in for post op and beyond. Hospitsl staff . Appalachian orthopedic surgeons perform revision surgery as well as mini-posterior and anterior approaches. It is a pity that medicine cannot be as definitive as science but relies on historic figures and the future outcome appears to be a statistical probability! Being discharged to a rehab unit is now the exception. Thank you, Lisa Blumthal. 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. Changes will take effect once you reload the page. 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). Many others feel the same. I am looking at how many hips they have done and where they are doing them. Very slow recovery. Remain upright . Talked to my foot doc and we decided on the Topaz procedure which has good results. Also I have read that there is a sharp learning curve that must take place in order to do the direct anterior approach. In my experience the approach used to replace a hip does not effect how quickly a patient recovers. Pain and disability are reduced. Diagnosed possible labral tear. I really dont know where to go from here. 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. 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. Should I look to another approach and surgeon? Thanks again! When the capsule is fully healed, it forms strong ligaments that will eventually regrow (it will take about 4 months for the capsule to form again). I have read your articles about procedures (anterior vs posterior). Doc says once recovered I should avoid flexion with adduction and internal rotation. 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 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. My surgeon mentioned also cutting something to free me up at the same time he will be doing the posterior approach surgery. I had a consult with a surgeon who does posterior and cuts muscle & tendons. Only Dr. Leone will be using the most recent hip technique known as the SPAIRE technique as of 2020. For risks she mentioned all the usual I knew about from the first surgery blood clots/loss, dislocation, etc. Thanks again! Results of the surgery numbness in the right thigh, inability to stand on the right leg, muscle atrophy all confirmed by EMG and second orthopedic surgeon. Does my prothesis not last as long since I am now doing a 3rd surgery? In the United States, a traditional posterior approach is the most commonly used. You can also change some of your preferences. Thank you for sharing with others the nerve supplements that youre finding affective. I did have numerous blood tests, MRI of knee and hip, total body scan with radio active injection, X-ray knee and hip etc. Please be aware that this might heavily reduce the functionality and appearance of our site. I dont think there is one best prosthetic. Some have features that are more suited to one persons anatomy and needs than others. Honestly, most 59-year-old active women do best with a well done THR. emergent norm theory quizlet. Dr. William Leone. The posterior approach for hip replacement surgery is by far the most common surgical technique used in the United States and throughout the world. It also keeps the surrounding muscles and tendons in place to reduce the risk of post-op pain and nerve damage. My surgeon is doing posterior and my reason is I am self employed with limited Time off available and hope to be back to work at least walking and driving in 4 to 5 weeks is this possible? I am 56 now and find that physical therapy and chiropractic care dont seem to be helping anymore. Do you have any advice or ballroom dancer THR stories to share? My mom is obese, short and has osteoporosis. I am now bracing myself for THR surgery within the next year and am wondering if there is any big advantage in trying to have this done by a surgeon who offers the customised implant, as above. Clots can form in the leg veins after surgery. 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! My surgeon uses the posterior approach. What is most important is choosing your surgeon. Welcome to Brandon Orthopedics! 2015 Aug. 3 (13):179. I am now 59, still in good condition but that is being compromised by lack of working out as my hips get sore from most everything I try. Patients understand the risks that metal joints and sockets bring to their long-term health and are moving away from the material. 1.2. Did you have the surgery via Superpath method? Does this mean my body may reject the metal of the post or cup? Very few metal-on-metal bearings are being placed today due to the serious potential of metallosis. The hip replacement needs to correct the abnormal hip mechanics that lead to the arthritis. Brian Tinsley. 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. Also on MRI there was a cyst (good size). I advise both my total hip and my total knee patients to avoid repetitive impact activities like distance running. Before proceeding, it is a good idea to review the recommendations and specific parts that your surgeon may recommend. The SUPERPATH technique is a tissue-sparing procedure. There is less blood loss with a single THR than a bilateral, hence less risk of needing a transfusion. But I feel that time could be lost and all my symptoms may become irreversible. 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. 2021 May 20;16(1):324 . If was 3 weeks after discharge This is used when the cartilage in the hip is severely damaged by osteoarthritis or other conditions. Three Cons of Hip Replacement Although total hip replacement is deemed a very safe procedure, there are associated risks that patients need to be made aware of before surgery. My surgeon does the SuperPath method. Im so pleased to learn that you had a good experience. Typically, most are eager to go home the very next day; many have already progressed to a cane, which they will not use very long. By adhering to the surgeons instructions as well as their pre- and post-operative instructions, you can reduce your chances of complications. Either and all body types lend themselves to the posterior approach because it is more extensile (can make it bigger and release more soft tissue structure if needed). If youre impressed by how clean it appears and the movement and professionalism of the staff, that obviously is a good sign. What surgical approach is typical for a complex total hip replacement? Some patients have no pain at all, which is remarkable. I would not recommend pushing your surgeon to use one specific approach or another. Thank you, Lisa. Do I have a risk of fractures during a posterior right hip revision due to my prior complications already? I would avoid the metal-on-metal articulation. SuperPath brings some of the best benefits such as; earlier ambulation, no loss of strength, quicker recovery, less pain, decreased dislocation risk, and easier exposure for future revision surgery. I think there may be increased associated complications. Patients can also have as little as a 3-inch incision. 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. I have been in excruiting pain and unable to do everyday normal activities. I do not want the approach to dictate the optimal construct which I hope will last 20 years and more. Your article lacks the pros of the AMIS and the cons of min invasive posterior. A major muscle is not cut during anterior hip replacement surgery, so pain is reduced and major muscles are not cut after the operation. Also available today are larger modular heads, made possible because our plastics are so much better than years prior. Over time, untreated hip dysplasia or hip impingement can lead to arthritis and, eventually, hip replacement surgery. Start your day off right, with a Dayspring Coffee In general, I would encourage you to consider all of your prosthetic joints a remarkable modern day miracle that must be cared for and respected. 1. Many studies suggest that any limp or clinical weakness resolves after approximately three months. Recovery time for anterior hip replacement is typically two to four months, and recovery time for posterior hip replacement is typically four to eight weeks. The size of the incision is determined by how large and tight the hip/thigh is and how much tissue (fat and muscle) exists between the bones of the hip and the overlying skin. In Dr. Lawrence Dorrs opinion, doctors and hospitals should not market a specific type of surgery as the most effective. Egton Medical Information Systems Limited. This is because the nerve is located in front of the hip. I encourage my patients to talk to other patients for whom Ive cared and learn about their experiences. 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. No special surgical equipment is required when performing a mini posterior. I do participate in competitions and showcase presentations. Im now 6 weeks out and doing good. I dont know what happens on that tablewas he in a hurry on Friday afternoon. Our overall findings suggested that the short-term outcomes of THA through SuperPATH were superior to DAA. What you can do is keep as good an attitude as possible and keep rehabilitating your leg. Most patients after a bilateral procedure would not go home but rather a rehab unit. Have you heard of something like this, and if so, is it worth it? 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. Im getting close to needing my left hip done. The development of a complete and secure surrounding scar tissue wall or pseudo capsule is critical for stability. Pam. This is particularly true if the person is overweight, has very muscular thighs or is short. Consuming excessive-fibre and wholegrain meals will assist to keep you feeling full, and will be Most traditional hip replacement models are metal-on-plastic varieties. I encourage you to do the same. Click on the different category headings to find out more. I had the mini-posterior at MGH hospital. Im sorry to hear that you struggled after your first, anterior-approach THR. I typically do hip replacement on the get anterior approach in 90% of my patients. Finally, hip replacement surgery is expensive and may not be covered by insurance. Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. 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. When a patient feels better, they can return to work almost immediately, though it usually takes two weeks or longer. SuperPath approach is the least invasive due in part to the minimal amount of tissue damage. 1000 NE 56th Street, Hi guys im 43 and live in Australia and due to have hip replacement in 7 weeks but im so confused as my surgeon is doing the posterior and im off work for 6 weeks where i here people having the anterior and going back sooner and no restrictions on hospital discharge any advice. Do you agree? An anterior approach hip replacement is one of the most minimally invasive surgical options for replacing a hip. I am wondering if having mild hip dysplasia is a factor in which approach is used. Infection. And does A really have none. But after reading your articles, I am hesitant about that choice now. Have you recovered by now? This can cause you persistent pain, stiffness . Fortunately, you have already experienced a THR and have done well. Two which are receiving the most attention are the traditional posterior approach and the direct anterior approach. In 2013 I had a THA done on the left hip. I deal with major nerve damage on front of thigh, almost whole thigh. Use of the forums is subject to our Terms of Use Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. Each question is scored from 1-5, with 1 being no problems and 5 being severe problems. In my experience, the restrictions (or those positions we ask our patients to avoid after surgery) have become much less limiting and are off limits for a much shorter period of time. I still have some questions I hope you can answer as this is so distressful for me. I wish you a full and uneventful recovery. If a mini posterior approach is used and the resultant total hip has optimally positioned components and balanced soft tissues, and was implanted through a smaller incision with less underlying soft tissue dissection and trauma, then I believe it is a benefit. This technique avoids cutting muscles and tendons, minimizing surgical trauma and improving the post-operative experience. We want the forums to be a useful resource for our users but it is important to remember that the forums are I have two questions one, how realistic would it be to try to have both hips done at the same time? I have a good surgeon (same one as last time) but I dont know how he would feel about my asking if a mini posterior (or posterior) procedure be carried out, so as to preserve as much strength in my right leg as I now have.Do as many muscles need to be cut in the mini posterior procedure? I saw a hip surgeon last year for an opinion, but because I had almost no arthritis on the x-ray he said he saw no need for surgery. The surgeon I saw said that my body structure and gait does not affect which approach would be ideal for my body. Can you please on the various points in the post and perhaps also elaborate on the last point. Does anyone ever attempt to do both at the same time if THR is determined? More soft tissue trauma can result do to this increased difficulty in exposure and then gaining more exposure if necessary. A metal or plastic implant is used to replace a damaged or diseased hipbone. Ill be 60 at the time and Im 54 and weight about 130 lbs in fairly good shape. I wish you the best of luck, Would you recommend treating plantar 1st? Also if the mini posterior approach is so effective when would it not be preferred over the regular posterior approach? The art of surgery should mimic a well rehearsed ballet or symphony. I would suggest seeking out doctors who specialize in hip replacement surgery rather than general orthopedics. Why would the doctor not have that at their finger tips? When compared to the anterior approach to hip replacement, which is typically more painful, there are several advantages to recovering from an anterior approach, including the fact that you will not be required to follow any specific anterior hip replacement precautions, such as bending or crossing your leg. From what Ive seen, most THR patients dont need very much PT, although I do encourage exercising in a pool. I think the recovery time is the same though. Please do not take this as an attack, but your article seems biased on your experience (great results with min. I am a 67 year old woman who has danced semi-professionally and has always been very active including doing Ashtanga yoga and caopeira.
Is Mambo Italiano Racist,
Charlie Spring And Nick Nelson,
Articles D