You are free to opt out any time or opt in for other cookies to get a better experience. I think it was sensible being careful on the other hand and I was told not to cross my legs. At the end of the day, I promise, it is not the approach but rather the person who is doing the surgery. Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. The doc I saw yesterday said 4 weeks. Had arthroscopy in Jan 15, cleaned up tear and arthritis. I assume PTHR is referring to partial hip replacement. Not only was my recovery twice as fast with the anterior, there was very little pain in comparison. Click to enable/disable Google Analytics tracking. Thanks. 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. I wish you a full and uneventful recovery. The first surgeon never mentioned this condition at all. Some surgeons believe that a patient who is neither obese nor overly muscular is a good candidate for anterior hip replacement surgery. I have the surgery planned, but then another medical professional warned me that the posterior approach will limit my twisting range of motion and prevent me from playing golf. The risk of revision surgery after a posterior hip replacement is the most serious concern. I thought the newer procedure on the special table was the best way to go. Personally I had the posterior approach and cannot see how I could have recovered any faster . They also are looking into methods to reduce the risk of infections in artificial joints. I have seen 2 doctors one doing posterior, the other anterior. All: The activity that I wish to have the most success with after the surgery is ballroom dancing. Help. For example, the stability of the components could have been achieved initially, but then proved inadequate so you developed either a loose cup and/or a loose stem. Complications from infection account for approximately 10% of all cases. I have seen 4 surgeons. I went with a total hip replacement. I have been in excruiting pain and unable to do everyday normal activities. I would not recommend pushing your surgeon to use one specific approach or another. This then becomes a very difficult problem to solve. Your primary goal should be to find a surgeon in whom you trust and who will take the workmans compensation insurance. Some of the most common considerations are age, weight, activity level, and the presence of other health conditions. Studying a hospital and physicians track record before you commit is important. I wish you a full and speedy recovery. It's cut off and removed through the hole. Pain and disability are reduced. Since a significant amount labrum has been removed, I think another attempt at arthroscopy would prove very disappointing and I would not recommend it. 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. Hip replacement surgery is typically performed in a hospital and requires at least one night in the operating room. Dr Leone, you make the point several times that the surgeon, not the procedure is most important. 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? 5. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. I would focus on the individual doctor, not the approach that the individual choses to use, to deliver the best result. 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. If your little voice is questioning if you are overdoing it or hurting yourself, then listen to it and ease up. The anterior approach, as a marketing tool, has grown in popularity among surgeons. There are many different quality implants (just like surgeons and hospitals). I am a 70 yr old female with a 4grade thickness loss at acetabulum and head of femur. A major muscle is not cut during anterior hip replacement surgery, so pain is reduced and major muscles are not cut after the operation. 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. The incision made for the operation can be as small as three inches. Traditional Hip Replacement - Traditional surgery requires a large incision of 10 to 12 inches and detachment of muscles from the hip. I have since read that hips with this condition might get worse after labrum repair due to this structural defect. It is important to consider the SuperpathTM technique if you are considering a hip replacement. Because the patient is lying on his back, it facilitates using a fluoroscope or moving x-ray throughout the procedure. Le has extensive experience in primary joint replacements, complex revision surgery, periprosthetic fractures, and infection management. Stay was 2.5 days. Other conditions, to which you alluded, such as having a back condition and an arthritic knee and foot, all can masquerade what the real or most debilitating problem is. Fewer narcotic medications are administered, resulting in a better overall recovery. I am deciding that my quality of life is in the toilet and need to get the THR done. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. Also there are concerns about disruption of blood supply to femoral head with this operation. There are hybrids of the surgey from what I can see. and Privacy Policy and steps will be taken to remove posts identified Dont let PR marketing confuse the big picture. What reasons would there be to use the regular over the mini? The bone isn't dislocated in surgery. I definitely didnt have any tendons or muscle cut and was cycling on the road from day 12 and back running at week 4 . An artificial joint is used to replace the worn out hip joint during a hip replacement procedure known as posterior hip replacement. Hip replacement is the second most common type of joint replacement, trailing only total knee replacement. Having diabetes and two organ transplants does significantly increase your risk for post-op infection as well as other complications. When the joint is held together by gravity and asymmetric anterior muscle tension, the tension between the ball and socket may change in various directions. He treats a variety of hip, knee, and shoulder conditions, and performs hip and knee total joint replacements. SuperPath approach is the least invasive due in part to the minimal amount of tissue damage. After reading your blog Im thankful he suggested this approach. Common conditions that often lead people to have either posterior or anterior hip replacement surgery include the following: Osteoarthritis Rheumatoid Arthritis Osteonecrosis, also known as Avascular Necrosis Injury Fracture Bone Tumors Have you ever performed the Mini on a patient 1 year after major open heart surgery? What are the experiences of other countries with THR? My surgeon has told me I will need PT 3 times a week for 6-12 weeks is this too long? 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. Clearly, he or she has earned your respect and confidence. I read hip dislocation is 28% higher after a revision, is it more then 28% after 2 revisions??? Your back does need to be evaluated as well. Im 56 years of age, 6 1 and 180 pounds. 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. Fax: 954-489-4584 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. Are expected to be out of bed (hips and knees patients) the afternoon of their surgery and at least taking a few steps if not walking. It turned out to be more torn than they thought and they had to cut about a forth of it out. I am a sixty five year old active male and need THR on my right hip. http://holycrossleonecenter.com/blog/hip-resurfacing-or-total-hip-replacement-a-candid-discussion/, http://holycrossleonecenter.com/blog/metal-on-metal-hip-replacements/, I wish you the very best recovery. It is difficult to get that from information which I find curious. You can be successful by staying healthy by sticking to less pain. We are always refining and trying to make it better. One advantage the ceramic-on-polyethylene carries is the lack of . I really dont know where to go from here. Can you compare/contrast to the other approaches; posterior, mini posterior, anterior? The hip joint needs to be replaced again when it no longer works properly because of a revision surgery. What are the risks involved? It seems that whatever their particular approach is that is what they sell. Because of this, when you're ready to get up and walk about again, engaging your muscles and hip flexors might be extremely tough. The hip is replaced without the need for surgery to dislocate the joint. I advise both my total hip and my total knee patients to avoid repetitive impact activities like distance running. The majority of teaching institutions in the United States continue to instruct as well as perform the traditional posterior as their primary approach. Hip implants are medical devices intended to restore mobility and relieve pain usually associated with arthritis and other hip diseases or injuries. I would encourage you to discuss your expected recuperation time and specific restrictions with your surgeon. Back then my surgeon advised me to perform a posterior surgery as opposed to anterior saying that I was overweight, short and a very muscular person and it would be easier and safer to do so. The second advantage of a small incision is that it makes it easier to clean and care for the hip. I understand they have good results in Thailand or India for half that. This does not necessarily mean they will have more pain or take longer to get well. The SUPERPATH technique is a tissue-sparing procedure which aims to get patients back on their feet within days (possibly hours) instead of weeks or months. If not, what will my restrictions be? In Dr. Lawrence Dorrs opinion, doctors and hospitals should not market a specific type of surgery as the most effective. Conserves the two main muscles that make up the front of the hip and upper thigh aspirated via the direct anterior approach. Infection: You are given IV antibiotics before and after surgery. Similarly, an engaged medical team needs to be available to help with care after surgery. If I think you may be a candidate, I will refer you to a doctor in our area that does. J Bone Joint Surg Am. She provided all kinds of benefits with this approach, as faster recovery, less motion restrictions et.al. I had the mini-posterior at MGH hospital. Many others feel the same. I would look for a surgeon who is busy, has a strong track record and who practices at a hospital with a stellar reputation and where many joint replacement surgeries are done. 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. The surgeon makes 2 incisions one bigger than the other on the rear side and separates the muscle and tendon to get to the hip instead of cutting the muscle and tendons to get to the hip. A orthopedic surgeon may insert a numbing agent directly into a new joint, which can last up to 48 hours. If you do not want that we track your visit to our site you can disable tracking in your browser here: We also use different external services like Google Webfonts, Google Maps, and external Video providers. These scores are not aggregated. Iliotibial (IT band) damage, had 2 months of ART release work on this issue. My two questions are: 1. SuperPath approach uses about a 3-inch incision at the side of . Is THR something that can help? The anterolateral approach or Watson Jones approach is one of the classical hip approaches that can produce excellent results when utilized for THR. 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. With a bilateral procedure during a single anesthetic, the blood loss would be double and there would be a much higher likelihood that my patient would need transfusion post-operatively. The surgeon accesses the hip joint from the front of the hip, rather than from the back or side. My question is, what will my restrictions be? That being said, if the foot is now a much bigger problem than the hip, you may have to deal with that first. Thank you, Rita. We thank you for your readership. I am feeling like this is a business like everything is else. These parts have a porous coating that the bone grows into. By far the most important variable is the doctor who is doing your surgery and managing your post-op care. Also, is it immoral for an 80 year old to have THR and cost the nations health care system $25 $35k? Achieving legs that feel equal in length after surgery is imperative. Thanks again! In the United States, a traditional posterior approach is the most commonly used. It is important that you find a doctor who is experienced in caring for people with complex issues. The other things that can affect the op is your fitness beforehand, your attitude and your age, although you may have difficulty getting younger!! This is described as a posterior approach because the actual hip . The mini posterior approach essentially is the same as the traditional posterior, however a smaller incision is made and less soft tissue is exposed. There is a 1-2% risk of fracture of the femoral neck. United States. The socket of the pelvis is machined into a hemisphere and a metal hemisphere is inserted into the socket. Thanks again! I would recommend having an honest discussion with the surgeons you are considering. There are a number of different potential surgical approaches available for hip replacement, each with their own potential advantages and potential drawbacks. When people loose independence and mobility, not only does the quality of life suffer, they are much more likely to develop a myriad of medical problems requiring even more-expensive and/or long-term care, including loss of independent living. Can you explain this approach? You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. All orthopaedic surgery demands a long recovery period. Thank you for sharing with others the nerve supplements that youre finding affective. Two which are receiving the most attention are the traditional posterior approach and the direct anterior approach. I will need the other hip done within the next 6 months, and despite all the talk of the anterior approach- I can use myself as the best judge to the best method. 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. He also used the term anterolateral. 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. Like you said, consistent outcome is important and this surgeon is excellent and I have great faith in him (Im a physical therapist and see his patients post-op so get to see the, at least short term, results myself). I very rarely transfuse any patients now. Spring 2014 had trouble playing tennis, hip kept feeling like it was popping out of joint, groin pain, aching. Possible Infections Dr. Sutphen: A minimal number of surgery patients (roughly around 1%) can develop an infection around their hip replacement. 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. Historically in my practice I performed many Bilateral THR and TKR and have backed away from that practice. If your surgeon did a great job, that is something to respect. 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. Fortunately you live in a part of the world where there are many capable orthopedic surgeons. I am 63 years old, 54, 115 pounds. 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 would consider talking to other patients who had their hips replaced by that physician and learn about their experiences. Registered in England and Wales. In severe cases, I will use my patients own femoral head, which is removed as a bone graft to help stabilize the new cup and garden new bone for the future. 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. 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. 1.2. Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. Not sure exactly what that means. I understand and respect that many surgeons prefer doing them simultaneously. Egton Medical Information Systems Limited. Being discharged to a rehab unit is now the exception. I would stay away from narcotics. I had to cut some strength exercises out leg lifts, hip sled. This robotic technique can assist in producing an excellent result. 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. Finally, I would choose a doctor with whom you connect and whose staff is engaged and knowledgeable. Posted What is SuperPath hip replacement? SuperPATH is a micro-invasive method of performing a standard total hip replacement where the surgeon utilizes a smaller initial incision and, more importantly, a very limited dissection in the deep tissues. Also I have read that there is a sharp learning curve that must take place in order to do the direct anterior approach. No specifics were given to me from the orthopedist . My acyive 60 year old husband is scheduled to have Mini posterior total hip replacement in 6 weeks. Many patients approach this by researching online and speaking to other patients who have been cared for at a particular facility. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. Thanks, 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. 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 May of 2015, I had a Labial tear repaired. I deal with OA lower back mess so know I see most likely how all this has played into the surgery. 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. Because my husband has circulation problems in his leg and vein removed for open heart surgery last yearhis surgeon recommended the Mini posterior surgery. Over time, some patients may acquire sensitivity or an allergy to the metal particles produced by the metal ball and socket. I am already limping when walking and was hoping that the limp would disappear after the hip surgery. I also would encourage you to choose your surgeon first not the procedure, approach or prosthesis. I then would strongly suggest you trust that person to decide what approach and what prosthesis predictably will deliver the best results. Return to the work place is an individual decision. 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. Your blog on anterior vs posterior approach was very informative. If I do a single hip or knee replacement, that patient is out of bed standing and, in most cases, walking the afternoon of surgery. In the dark to find out about this myself. I had a posterior, the surgeon did not cut any muscle, they just move them now. 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. There is also a small risk of infection at the surgical site. I was really careful bending etc for four weeks until I saw the physio, who said "oh you could have touched your toes if you had wanted to!" I would avoid the metal-on-metal articulation. It sounds like he did fabulous job. Glad that after lots of PT and massage and medial branch block for back issues with NO!!! Update what hes cutting is the adductor so my question is the same is this just a normal part of some THRs? With degenerative osteoarthritis of the hip developing secondary to a severe slipped capital femoral epiphysis (scfe), recreating normal hip mechanics after THR may have necessitated lengthening the first hip. Therapy hopefully will help any contractures and scaring within your muscles that might have developed after surgery. Before my hip problems, I really enjoyed playing golf and would like like to play again after surgery. Many people seek anterior hip replacement due to the unbearable pain they feel in their hip joints. It requires surgical insight and skill to accomplish. 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. You can resume your active lifestyle as soon as possible thanks to a new prosthetic hip. A modern artificial hip joint is designed to last for at least 15 years. First, I am a little bit scared. I still have some questions I hope you can answer as this is so distressful for me. This interval must be developed and the muscles must be separated in order to reconstruct the hip. Do you also do arthroscope surgery? Recognize that the underlying etiology is not being corrected by this procedure, so relief of symptoms probably will be temporary and possibly partial. I think cutting muscle was in the past. So im going back to the surgeon that did my left hip and left me in agonizing pain for 2 months after procedure. It healed well but then I got major psoas pain which a cortisone shot helped. I decided to stick with my trusted orthopedic surgeon (who did two knee scopes on me) who believes the minimally invasive posterior approach is the safest approach. Sitting seems to irritate it the most. 35 (2):153-62. Felt very uninformed and left Maybe someday our nations health care system will measure up to that of France, Norway, Switzerland and others, in which their governments are investing half of the GDP that we are wasting. Im getting close to needing my left hip done. I dont think one surgical approach is better or worse than the other for you to accomplish this. 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). Click to enable/disable _gat_* - Google Analytics Cookie. 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. Mine certainly have. Your symptoms still sound mechanical, positional and episodic. Glazener C, Fraser C, Hutchison J, Vale L. Single mini-incision total hip replacement for the management of arthritic disease of the hip: a systematic review and meta-analysis of randomized controlled trials. The most common type of total hip replacement is done in the anterior anterior part of the hip. Soon my right hip started bothering me. Overall, it sounds as if youve had an excellent result and wonderful recovery following your hip replacement. Email us. As of 2020 only Dr. Leone is using the latest hip technique called the. I often suggest to my patients that they speak to other patients for whom Ive cared and to whom they can relate to learn about their experiences. 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. Lateral femoral cutaneous nerve injury is the most common injury incurred during an anterior approach. Im sorry to hear that you struggled after your first, anterior-approach THR. Further, rehab after hip arthroscopy often requires partial weight bearing on the operative side and that would be difficult with newly operated THR on contralateral side.

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