As a result of the interventions, the surgeon has a better view of the hip joint. This is actually a good sign. They may have a certain cut-off criteria (for example, a BMI of less than 35). 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. One thing I do not want is any muscles or tendons cut in the procedure. Patients can also have as little as a 3-inch incision. More likely, its because ones activity increases after the first THR. 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!). Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures.A total hip replacement (total hip arthroplasty or THA . I wish you the best of luck. Some surgeons believe that a patient who is neither obese nor overly muscular is a good candidate for anterior hip replacement surgery. Because of the straightforward exposure of the femur, there is less risk of femoral fracture or poor implant positioning. We can help you make the best decision for your knee replacement, and our friendly staff is available to answer any questions you may have. Email us. People who have anterior hip replacements tend to stop using walkers, canes, and other aids 5 to 7 days sooner than people who have conventional hip surgery. Even in my practice, which is starting its 27th year, we continue to refine the surgical procedure, pre- and post-operative instructions and rehab (this is huge), pre- and post-operative pain management, and even anesthesia. Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? Nobody wanted to talk This improved quality of life will be beneficial. Cons of Robotic Assisted Surgery As with any type of procedure, Mako is not without its drawbacks. 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. I spoke in person to probably 4-5 of his success patients and went with hearing from them. 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? It is critical that the patient and the doctor consider whether the patient is a good candidate for surgery, the cost and recovery time, and the surgeons expertise. There is less risk of neurological injury. In my 25 years of practice, the variable that seems to have changed the most is how quickly people recover from this surgery when done well. Very important with both the traditional posterior and the mini-posterior approaches, if the surgeon is not able to visualize critical structure adequately, or if a problem were to arise such as a fracture, then either approach can easily be adjusted. 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? 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. This can be dangerous because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. Should I go for this or should I opt for the mini posterior. Also, after an accident, I had 12 screw and an L shaped plate in my heel. It is a mix of anterior & posterior. This left hip remained tender based on my exercise level which I did modify but always my hip had some soreness. Being out of bed and moving soon after surgery adds to a patients safety and speeds the recovery. Hip replacement currently consists of two major approaches: direct anterior and anterior approaches. Help. In hopes that THA would let me live my normal life without arthritis, instead I can barely walk more than 100 yards without having to stop, my gait is crooked causing lower back problems and my personal life is less than perfect. Regardless, the overall incidence of dislocation for every approach is smaller due to use of larger femoral heads and enhanced closure techniques. I am 5 weeks out and have been doing beautifully! 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. 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. I am a 49-year-old female. Occasionally this even requires making a second, separate incision. I assume PTHR is referring to partial hip replacement. However, some offer greater patient benefits than others. My main concern is that I have a tilted sacrum and a very sway back. I then would trust your doctor to select the prosthetic that would deliver the best result according to your goals and allow you to return to activities that you enjoy. This technique is also referred to as the . I have seen 4 surgeons. Fewer narcotic medications are administered, resulting in a better overall recovery. Remain upright . External rotation of your feet should be limited (avoiding them twisting to the outside as Charlie Chaplin does) and hip hyperextension should be avoided. Thank you, Rita. There is a 1-2% risk of fracture of the femoral neck. Share your concerns with your surgeon. We thank you for your readership. Many people seek anterior hip replacement due to the unbearable pain they feel in their hip joints. Inpatient footage of the patient compilation has been edited out to accommodate hospital rules. Are these expectations realistic? Should one of these events occur during a mini-posterior procedure, they are easier to recognize and correct. When done well, your body does well with this technology. I, too, am struggling which approach to have. The impingement can lead to a levering out of the ball from the socket. I have not seen this before because in the past, the complication from hip surgery were sciatic nerve injury from posterior approach. I know the most important decision you will make is choosing the doctor who will perform your surgery. The femur is prepared with the head and neck intact reducing the chance of fracture. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. There are a few complications that can occur with anterior hip replacement surgery. It's cut off and removed through the hole. Patient does not provide medical advice, diagnosis or treatment. 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. I deal with OA lower back mess so know I see most likely how all this has played into the surgery. 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. 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 was discharged within 24 hours. Patients are typi. Since I previously had both knees replaced (by another surgeon) about 5 years ago and still have problems with the knees i.e. Posted All rights reserved. Between your legs, you should sleep with a pillow for the next six weeks. Just getting your thoughts I will discuss it more with my surgeon at the pre-op meeting. I feel that at 10 weeks with profuse denervation potentials on the quad muscles, the prognosis is not good, even at 6 months. Contact Dr. Moor, Orthopedic Surgeon at Advanced Sports Medicine Center. Contact Us, Approaches 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. One advantage the ceramic-on-polyethylene carries is the lack of . Further, I would contact your insurance carrier and the hospital so you will not be surprised with any unexpected costs. This complete wall of tissue that surrounds the new hip imparts stability. Traditional hip replacement surgery is no longer an option, but it is less painful and has a number of advantages. It is critical that the patient is aware of the risks, benefits, and alternatives of the procedure. Anterior hip replacement has the potential to cause complications and pose some risks. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. 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. If your surgeon did a great job, that is something to respect. I am totally confused and dont know which procedure to choose. How long will my hip replacement last? 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. I began using the superior approach for total hip replacement in February of 2014. . Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. This risk is greatest in older females with bone of sub-optimal quality. 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. Ill know a lot more after we meet and I review your X-rays. 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. Years ago, experts assumed that anterior hip replacement had lower rates of hip dislocations and nerve damage than other forms of hip replacement. If your little voice is questioning if you are overdoing it or hurting yourself, then listen to it and ease up. Dr. William Leone. But after reading your articles, I am hesitant about that choice now. A major muscle is not cut during anterior hip replacement surgery, so pain is reduced and major muscles are not cut after the operation. 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. An anterior hip replacement does not have any limitations based on comfort. Is it really as good as it sounds? The activity that I wish to have the most success with after the surgery is ballroom dancing. By 2016 and over 300 SuperPATH cases, the results of very first 100 SuperPATH surgeries (the so called 'learning Curve') were published in a peer reviewed journal with . The rule of thumb is that recovery occurs over a 12-18 month period following injury. 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. I am a competitive tennis player in my age division. I then stage the second surgery as early as 2 or 3 weeks post-operatively. Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. 1. 2. It is critical to consider the pros and cons of each option before making a decision. Since then, SuperPATH has enjoyed excellent success. All: Six weeks or longer is the exception. In 2013 I had a THA done on the left hip. It does mean the surgeon has lots of room to move about though!! With much respect I look forward to your reply. Walking is the best exercise. Following anterior hip replacement surgery, avoid soaking in hot tub, sauna, or swimming pool immediately after surgery. It does sound as if proceeding with a THR is appropriate, since your attempt to repair the joint arthroscopically did not pan out. The hope is that your nerve injury will recover with time. Always speak to your doctor before acting and in cases of emergency seek About my surgery: I had to wait 30 hours before surgery, two days later I was released, within two more days I stopped using my walker. Ann Transl Med. Is AL better than P for this? The hip joint needs to be replaced again when it no longer works properly because of a revision surgery. My surgeon uses the posterior approach. Pam. Dear Dr. Leone: 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. The mini posterior approach works wonderfully and predictably when expertly performed. Anterior hip replacement is a type of hip replacement surgery. The posterior approach, then, is less inherently stable but may or may not require precautions. You are free to opt out any time or opt in for other cookies to get a better experience. My problem isnt from a worn-down joint with no cartilage. Bleeding at the operative site can occur as a result of an anesthesia reaction, such as an allergic reaction. If so, is it possible to have both hips done at the same time? Finally, I would choose a doctor with whom you connect and whose staff is engaged and knowledgeable. My doctor does the Posterior approach, he didnt say anything about the mini part. The hip is replaced without the need for surgery to dislocate the joint. On the other hand, there may be a slightly increased incidence of anterior instability. Not wanting to go through all the restrictions, I was considering anterior for my right hip, which would require not having it done locally since doctors here have been doing it for only 1 year. 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. crackling noise/pain, cannot bend them or kneel in church or get on the floor to do exercises, I am very afraid to ending up in a wheelchair or having to use a walker the rest of my life.I am a very active 65 year old, and very, very worried about the hip surgery. We are always refining and trying to make it better. Because the muscle fibers are separated, not cut, the nerve path is not disturbed and the muscle is not injured. Apples to apples which procedure has the lowest incident of complications? I also would encourage pool walking or swimming. I had the mini-posterior at MGH hospital. 3. It is critical at time of surgery that an excellent range of motion be created without impingement. United States. They may be: Cemented to the bone. Brian Tinsley. It helps the surgeon implant the acetabular component in a very precise position. We are always refining and trying to make it better. An anterior capsule is the only soft tissue cut during this procedure to insert the implants. I have/had arthritis in my hips. Im pleased that you will be coming in for an appointment. I understand and respect that many surgeons prefer doing them simultaneously. But I feel that time could be lost and all my symptoms may become irreversible. I have seen 2 doctors one doing posterior, the other anterior. A miniposterior approach uses the same intervals as the standard posterior approach but simply less tissue is released for the exposure. I think it was sensible being careful on the other hand and I was told not to cross my legs. J. Dear Dr. Leone, There are many factors that contribute to whether or not someone is a good candidate for anterior hip replacement surgery. 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!! 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. I think its vitally important that you go into surgery truly believing in your heart that you are going to do well, and that you are with the best surgeon and team who will help you. Because the gluteus medius and minimus lie over the anterior capsule and insert into the greater trochanter, it does require greater trochanter osteotomy or more commonly a partial elevation of these muscles from their insertion, which can lead to damage.