Will I still be able to do all of these things? Are my findings that posterior approach in my situation would have been more appropriate? Not sure exactly what that means. Also, patients with shorter femur necks and genu varus (lower angle between the shaft of the femur and the femoral neck) are more difficult anteriorly. Ten years ago I had total hip replacement on the left at hss. Posterior, mini posterior or anterior? I had a consult with a surgeon who does posterior and cuts muscle & tendons. Although Superpath hip replacement is often a safe treatment, it may be associated with certain concerns, such as increased postoperative pain, as with any surgical procedure. Patient does not provide medical advice, diagnosis or treatment. The surgeon I went to said he does THR using a lateral approach. I very rarely transfuse any patients now. I would like your opinion on the stem cell injections as I am really afraid of the second surgery on the same side of my body. So my concerns include having the range of motion to perform moves like promenade where my body is roughly facing forward and my right leg will take a step left across my body at about 90 degrees. Have you ever performed the Mini on a patient 1 year after major open heart surgery? 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. Please be aware that this might heavily reduce the functionality and appearance of our site. The first surgeon never mentioned this condition at all. Dr. My surgeon uses the posterior approach. 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. I have seen a number of patients who were reconstructed with the anterior approach who developed painful anterior scarring after the procedure. Does it really not matter which approach I have, posterior or anterior? Even after the procedure is completed and the patient is on pain medications, pain and discomfort may occur in some cases. Comments about life-long hip restrictions between Posterior, Anteriorlateral and Anterior approaches? Conclusions SuperPATH approach showed better results in decreasing incision length and early pain intensity as well as improvement of short-term functional outcome. I am just under 5 ft and weigh 185. There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. When a patient feels better, they can return to work almost immediately, though it usually takes two weeks or longer. Dr. William Leone. My husband has a plastic valve (done in 86) and synthetic assending aorta and triple bypass (done in 2013)very successful surgery. The main limitation after surgery is a lack of comfort. The development of a complete and secure surrounding scar tissue wall or pseudo capsule is critical for stability. I live in Staten Island and need rt hip replacement. The mini posterior approach essentially is the same as the traditional posterior, however a smaller incision is made and less soft tissue is exposed. Clearly, he or she has earned your respect and confidence. Irrespective of the approach that is used to implant the prosthesis, the tissues that surround the new prosthetic hip must heal and mature if the hip is to achieve stability. Fax: 954-489-4584 If theyre really happy and got well quickly, you probably will too. Also available today are larger modular heads, made possible because our plastics are so much better than years prior. Blood clots or bleeding. There is a chance of nerve injury with any type of hip replacement. This is because the nerve is located in front of the hip. It also keeps the surrounding muscles and tendons in place to reduce the risk of post-op pain and nerve damage. Following the anterior approach, we provide you with a number of precautions and positions that you should avoid if you are in danger of being discomfited. 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.. If so, how long until I can get back to normal living? When a dysplasic hip is reconstructed to THR, its important the abnormal mechanics are corrected, typically by medializing (closer to the midpoint of the body or bladder) the cup. The following cookies are also needed - You can choose if you want to allow them: You can read about our cookies and privacy settings in detail on our Privacy Policy Page. 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). Im pleased that you will be coming in for an appointment. My legs are very muscular and trim. Every . Once again, it sounds as if you had a wonderful surgeon, which is the most important variable. 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!). Its been six months since surgery, my operating doctor keeps feeding me with lets wait another month stuff. A shorter hospital stay and faster recovery are typical of this because there is less damage to the muscles. Because the anterior hip replacement surgery is a minimally invasive procedure, no cuts are made to the muscles surrounding the hip. There are various ways of doing a hip replacement. Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. My surgeon wants to use the posterior approach and indicates that I eventually should be able to play golf again. Rush joint replacement surgeons are leaders in hip replacement surgery and research. A major muscle is not cut during anterior hip replacement surgery, so pain is reduced and major muscles are not cut after the operation. What Ive been able to achieve is find two nerve supplements that have taken away the burn/tingle on my thigh. In comparison to traditional methods, anterior approaches to the hip joint are more effective. You should not proceed unless you know in your heart that you will be taken care of in a manner that has the best chance of giving you as perfect a result as possible. (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. With much respect I look forward to your reply. I know the most important decision you will make is choosing the doctor who will perform your surgery. Do either of your techniques require the traditional anterior or posterior precautions? Soon my right hip started bothering me. It sounds as if you had a wonderful surgeon. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. Choose your surgeon and not the approach or prosthesis. 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. In my experience the approach used to replace a hip does not effect how quickly a patient recovers. He also used the term anterolateral. My gait is off partially due to my hip but also I believe because of my body structure. I have two questions one, how realistic would it be to try to have both hips done at the same time? The doctor is planning a traditional posterior. I would not change the position of the components. All orthopaedic surgery demands a long recovery period. There are a few disadvantages of anterior hip replacement that patients should be aware of before undergoing the surgery. It helps the surgeon implant the acetabular component in a very precise position. Again, trust your doctor. When it comes to revision surgery, we rely heavily on the posterior approach. Have you heard of something like this, and if so, is it worth it? The highly crossed linked polyethylene liners are now the gold standard in this country. Nobody wanted to talk Many also mate this with a ceramic femoral head. Some of the most common considerations are age, weight, activity level, and the presence of other health conditions. Some patients report that symptoms increase in the not-yet reconstructed hip because of the leg length inequality. Thanks! Very sorry to hear of the difficulties you experienced! Everything does point to posterior being the better of the two, but first i wasnt given a choice, and much easier said to shop for surgeon, than to do it, when only one in this area takes my insurance. That being said, you should have the additional surgery where you feel you will have the best chance of doing well. The pain I get is in the groin and a sharp pain in the buttocks, that feels like muscle pain. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. I think tennis, dancing and horseback riding are fine. The experiences will vary greatly . In the United States, a traditional posterior approach is the most commonly used. SuperPATH showed better results in decreasing operation time, incision length, intraoperative blood loss, and early pain intensity. Most patients after a bilateral procedure would not go home but rather a rehab unit. Some in the early period have good track records, others do not. Hard-on-hard bearings, such as ceramic-on-ceramic as well as metalon-metal articulations, also resulted in larger femoral heads being implanted. I also have undiagnosed neuropathy in both legs from the knees down. With that said, I would have probably just done the posterior with you if we lived in the US based exclusively on the time you take to respond! Click to enable/disable Google reCaptcha. In 2014 I had to do another THA, this time on my right side. Currently, I seldom do bilateral THRs under a single anesthesia but instead stage the surgeries 2 1/2 to 4 weeks apart, depending on my particular patient and his or her needs and desires. I would then let that person decide with what approach they think they can best accomplish the surgery and deliver the best result. July played my last match when I buckled. 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. 3 years ago, What surgical approach is typical for a complex total hip replacement? I have a tilted sacrum, sway back and a very large posterior. I am experiencing pai. There are a few disadvantages to hip replacement surgery. It exploits the inter-muscular interval between the tensor fascia lata and the gluteus medius. Complications from infection account for approximately 10% of all cases. 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. Posted If your little voice is questioning if you are overdoing it or hurting yourself, then listen to it and ease up. The posterior approach is used frequently again, in large part due to the fact that it is an extensile approach. 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. What you can do is keep as good an attitude as possible and keep rehabilitating your leg. Total hip replacement is a step-by-step surgery to replace the hip socket and the ball at the top of the thighbone (femur). Clots can form in the leg veins after surgery. Lift your knee rather than your hip at the same time. Dear Jo Anna, But this blog was a nice nudge toward the posterior. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. As long as you do the necessary surgeries, you will eventually break your femur, but only if you do enough. Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. That being said, I agree completely with your surgeons advice to have a total hip replacement and not a hip resurfacing. With SuperPath, there is no surgical dislocation of the hip. First, I am a little bit scared. Click to enable/disable _gid - Google Analytics Cookie. If its a struggle, then the situation needs to be reassessed. A orthopedic surgeon may insert a numbing agent directly into a new joint, which can last up to 48 hours. Getting in and out of cars, and turning over in bed. Ill know a lot more after we meet and I review your X-rays. Its been a couple months and I thought Id drop in with an update..over 4 yrs post op and I deal with Femoral nerve damage from Anterior, and found others who deal with the same.it may lessen with more years but who knows.Somewhere I read 15% or so end up with this..I talked 2 other people in my city, same surgeon and they have had this issue to. Im an avid skier and just found out I did not have full Anterior but rather AL. An anterior hip replacement procedure, on the other hand, performs the same function as an anterior hip replacement in terms of tissue shaving. Changes will take effect once you reload the page. Does anyone ever attempt to do both at the same time if THR is determined? Thanks again! [QxMD MEDLINE Link]. If you refuse cookies we will remove all set cookies in our domain. My right leg is already a bit longer than the left. The activity that I wish to have the most success with after the surgery is ballroom dancing. With a significant learning curve, it is likely that you will have to replace about 100 hips before you are truly comfortable with the approach. Many modern-day femoral stems are considerably smaller or more bone sparing than well-functioning stems of the past. Almost all bilateral THR or TKR patients go to a rehabilitation facility after their acute stay, not home. I'm scheduled for THR on the 22nd. I was thinking of doing that 1st, maybe April(Ill be in boot 4 weeks), and then the PTHR in either Sept or next Jan when I have free time. After reading your article I am concerned about the issues you discussed. Complications A mini posterior approach is a modification of the classical posterior approach. My two questions are: 1. Being discharged to a rehab unit is now the exception. It turned out to be more torn than they thought and they had to cut about a forth of it out. I have had both hips replaced about 13 months apart, one anterior and one posterior, and there is no doubt that I would recommend anterior. It sounds like he did fabulous job. 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 advice is to have a frank discussion with your surgeon and share these concerns. Hip replacement surgery is typically performed in a hospital and requires at least one night in the operating room. Most of the restrictions are removed at that time, although I still advise common sense, particularly for the first three or four months. SuperPath approach is the least invasive due in part to the minimal amount of tissue damage. Finally, hip replacement surgery is expensive and may not be covered by insurance. When asking a prospective surgeon about the anterior vs posterior approach he told me that it is necessary to use a smaller prosthesis which would not be as stable with the anterior approach and did not recommend it for this reason. Since 1995, there has been an extremely low dislocation rate and an infection rate of zero percent. This site uses cookies. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. It healed well but then I got major psoas pain which a cortisone shot helped. Thanks for any feedback. 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. If possible, speak with other health professionals who work at the hospital or at least in the same geographical area. Reconstructing the opposite hip hopefully will result in legs that feel more equal. 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. This allows you to resume normal daily activities quickly while also returning to normal range of motion and function. 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. THR if a MRI or Pet Scan isnt done? My recommendation is for you to discuss this with your surgeon if you have further concerns. That means you have an excellent track record. Ive done PT and plan to continue working on strengthening my core and flexibility of those large muscles. respect of any healthcare matters. I am a 55 year old with a labral tear and moderate arthritis. I, personally, have not had a patient dislocate following a primary total hip replacement in many years. 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. Further, the extent of dissection is more minimally invasive, which also improves stability. Considering I had no idea about differences between the two approaches, I said OK and surgery did go well and I was back on my feet in no time. Possible Infections Dr. Sutphen: A minimal number of surgery patients (roughly around 1%) can develop an infection around their hip replacement. Total hip replacement is one of the most successful operations ever developed and is a remarkably predictable way to relieve pain from arthritic conditions. A couple of things I am hoping you will explain using laymans termology. Because the mini-posterior is more straightforward, many surgeons think it provides an increased margin of safety for the patient, because the incision can easily be extended if exposure is poor, or if a fracture occurs. Driving hurts too. Losing weight and strengthening your muscles pre-operatively will make surgery easier and greatly facilitate your rehab. I read hip dislocation is 28% higher after a revision, is it more then 28% after 2 revisions??? Nerve regeneration can occur up to 18 months following injury, but the chance of full recovery decreases with delay in recovery time. Having a THR is a major undertaking and it is reasonable to expect the hip construct to function optimally for twenty and more years. My walking is very limited, shoe is built up as leg is shorter and in recent months Ive realized my leg is bowed. There is also a small risk of death associated with any surgery. Tina, which procedure did you have? What, if anything, can be done to revive femoral nerve and get my thigh muscles back in normal? Otherwise you will be prompted again when opening a new browser window or new a tab. But I feel that time could be lost and all my symptoms may become irreversible. emergent norm theory quizlet. All rights reserved. Getting those studies will not change the reality that you will need THRs. Because of the concerns of posterior dislocation, in the past patients were taught certain positions to avoid. Doc, Ive worked out and been physically active forever running, biking, skating, etc. Good question. The parts may be attached to the bones in one of two ways. Share your concerns with your surgeon. 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. Which approach did the doctor take? 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. The vascular supply of your leg must be assessed preoperatively as part of you work-up, but most do very well. The hope is that these new designs will, but time will tell. 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. Achieving legs that feel equal in length after surgery is imperative. 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. Before proceeding, it is a good idea to review the recommendations and specific parts that your surgeon may recommend. Thanks again for this great blog! I am so sorry to learn that you have had such a bad experience after THR. Each approach has advantages and disadvantages. The most important thing is that tissue is handled gently and trauma is minimized, whichever approach is used. Infection: You are given IV antibiotics before and after surgery. Many others feel the same. Being cared for in a hospital that specializes in joint replacement and has an extensive specialty medical staff also is key. The questions youre asking are 100 percent appropriate. I am deciding that my quality of life is in the toilet and need to get the THR done. 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. In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. Dear Doctor Leone, 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. I think the money you spend to have a hip replacement is more than just moral or justified, it is smart business. After all, no matter the age, it will determine the likelihood of maintaining your mobility and independence. You should feel good that you are aware of your fears and that it hasnt paralyzed you into not acting. This is not true for bilateral cases. Should one of these events occur during a mini-posterior procedure, they are easier to recognize and correct. There is less risk of neurological injury. Will I be able to dance, hike, bike, swim, exercise after a 3rd surgery? 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. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. The nerve which supplies sensation to the front and side of the thigh is vulnerable. 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. What do you consider to be the most important factors in choosing a surgeon? My first bike ride was 22 miles without any problems. Thank you, Lisa. I have the hospital but am deciding on the surgeon and which approach is best. In my practice, I cement an Exeter stem in a significant percentage of my patients who undergo THR . Sometimes, when a surgeon is working too hard to reconstruct through a very small incision, the ends of the incision tear and the tissues are traumatized. That being said, if the foot is now a much bigger problem than the hip, you may have to deal with that first. But Im impressed with your blog and responses, so am writing to ask you about an apparently new procedure in which the surgeon uses a customised implant, utilising pre-operative 3D CT scanning. I had good results into 5th month post op and then everything went downhill. If they did develop five months post-op, then you have to consider that it could be a manifestation of back pathology compromising a nerve root. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. I would not recommend pushing your surgeon to use one specific approach or another. 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. Adult patients who have a deteriorated hip may be candidates for total hip replacement. disadvantages of superpath hip replacement. We are always refining and trying to make it better. 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 . I am wondering if having mild hip dysplasia is a factor in which approach is used. This approach has a number of potential advantages, including a shorter hospital stay, less pain, and a quicker recovery. 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. 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 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.

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