The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. Why is that? Thanks! As a result of anterior hip surgery, there is little need for any special care. The chances of developing a revision surgery after a posterior hip replacement are low, but you should keep all follow-up appointments with your surgeon and inquire when you can resume activities that go beyond 90 degrees or bend down to pick up something small after your procedure. Also if the mini posterior approach is so effective when would it not be preferred over the regular posterior approach? The hope is that your nerve injury will recover with time. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. 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. Thru X-rays Ive been told both hips are bone on bone! One thing I do not want is any muscles or tendons cut in the procedure. I have read your articles about procedures (anterior vs posterior). In some individuals, it takes much more force and dissection in order to accomplish this (typically, there is significantly more bleeding from an anterior approach compared to a mini-posterior approach). The technique allows recovery that is as rapid as a mini-posterior approach while conferring stability of the hip joint that is equal to other exposures that . I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. Finally, I would choose a doctor with whom you connect and whose staff is engaged and knowledgeable. Simply, we keep trying to get better. A hip replacement is an excellent option for people who suffer from significant pain and disability as a result of arthritis in the hip joint. The information I have gathered seems to indicate the anterior approach is more inherently stable, making precautions unnecessary. I really appreciate this website. I am looking at how many hips they have done and where they are doing them. Anterior vs. Posterior, Posterior vs Mini-posterior. Introduction 2 x week. appropriate medical assistance immediately. We now have too many other proven bearing surfaces available. Also, some body structures or anatomy makes approaching a hip anteriorly much more difficult than others. I find that patients who are well informed and know what to expect prior to surgery get well even faster. I have been doing ALOT of research about the different approaches to THR and looking for the absolute best surgeon. I wish you the very best, In the United States, a traditional posterior approach is the most commonly used. SuperPath Hip Replacement Surgery Chesterfield | SuperPath Hip Surgery An anterior approach hip replacement is one of the most minimally invasive surgical options for replacing a hip. Almost all bilateral THR or TKR patients go to a rehabilitation facility after their acute stay, not home. Fortunately, the incidence of hips dislocating after THR is very small, especially after first-time hip replacement. Im a very healthy long distance bicycle rider. Surgical Techniques 2. You are free to opt out any time or opt in for other cookies to get a better experience. Adult patients who have a deteriorated hip may be candidates for total hip replacement. Dr. Leone, I am coming in to see you for an appointment for a THR to my left hip. Thank you. I had the posterior approach, the surgeon did not cut any muscle plus I had no pain at all after the op. There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. It is critical to make the right decision regarding anterior hip replacement surgery in each case. Each approach you list has advantages and disadvantages. 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. Mayo Clinic researchers have studied ways to reduce blood loss, control pain and speed recovery for people who undergo hip replacement surgery. Regarding restrictions after your hip replacement, this too is an area that has changed drastically over my 25 year career. Patients can also have as little as a 3-inch incision. All have advantages and disadvantages. His hip ball was put back in the socket and he has done beautifully since. Femor fracture. Also available today are larger modular heads, made possible because our plastics are so much better than years prior. An anterior approach to hip replacement allows the surgeon to perform more limited views of the hip joint during the surgery, making the procedure technically challenging for less experienced surgeons. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. I had the surgery on June 22 and I am about 5 weeks post op. During anterior approaches, fracture repair is much more difficult and necessitates the use of a separate incision. 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 . Being discharged to a rehab unit is now the exception. SuperPath Hip Replacement Baton Rouge | SuperPath Surgeons Baton Rouge My worry is that I will end up with one leg shorter than the other. They may be: Cemented to the bone. I am a very active and young 69 year old female who had a THR on my left side 5 years ago. It turned out to be more torn than they thought and they had to cut about a forth of it out. An anterior hip replacement is, in many ways, less risky than any other type of hip replacement. 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. This is because the nerve is located in front of the hip. It is also possible to have an anterior hip replacement during pregnancy. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. Hip replacement surgery & recovery time | TRIA Orthopedics - HealthPartners It is nice to see honest Q&A versus a marketing page. I wish you the best of luck. This can be dangerous because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. That means you have an excellent track record. Only Dr. Leone will be using the most recent hip technique known as the SPAIRE technique as of 2020. As a result of this precaution, it is difficult to sit on low chairs, sofas, or toilets. If theyre really happy and got well quickly, you probably will too. I have had to modify my activity level by cutting back greatly and also trying new activities that might not strain my hips so much(tried water walking in the deep end which cause deep pain for 2-3 days afterwards). Lift your knee rather than your hip at the same time. A modern artificial hip joint is designed to last for at least 15 years. I suspect that your surgeon has continued to refine his or her technique based on experience over the past five years, in the same way I have. Since I previously had both knees replaced (by another surgeon) about 5 years ago and still have problems with the knees i.e. Most patients are able to walk the day of surgery. Original Medicare (Part A and Part B) will typically cover hip replacement surgery if it's medically necessary. I am a South African and need to make a decision on whether my mother (69) goes for an AMIS or traditional posterior. What are your thoughts on the use of robotics? There are hybrids of the surgey from what I can see. As of 2020 only Dr. Leone is using the latest hip technique called the SPAIREtechnique where patients no longer have hip precautions after surgery. I have linked back to several blog posts below that will give you more in-depth information. Many believe that this results in less risk of infection. 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 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. Gary. 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. J Bone Joint Surg Am. I exhausted all other non-surgical options, such as physical therapy and meds but to no avail, so now plan to have a THR in March. I am seriously looking at the infection rate at each facility. I am having the mini posterior done in June and my surgeon gave me the pros & cons of both. Dr Leone, you make the point several times that the surgeon, not the procedure is most important. 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). Contact Dr. Moor, Orthopedic Surgeon at Advanced Sports Medicine Center. In comparison to traditional methods, anterior approaches to the hip joint are more effective. Personally I had the posterior approach and cannot see how I could have recovered any faster . Any info would be appreciated. Ultimately, you and your husband need to choose the surgeon who you both feel will provide the possible best care, based on reputation and your personal comfort level. Sometimes the pain goes away as I walk and sometimes it doesnt. This is actually a good sign. It does mean the surgeon has lots of room to move about though!! Dr. The intended interval between the front thigh muscles can be difficult to recognize and there has been an associated increase in injury to the femoral nerve or vessels. Fitness going into surgery and speed of recovery seems to be a common theme though. 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. Additionally, there is a small risk of dislocation after surgery, which can be painful and may require additional surgery to correct. Your frustration is completely understandable. Because of the straightforward exposure of the femur, there is less risk of femoral fracture or poor implant positioning. Surgical approach is important but its just one of many important variables. Many of these stems have very little if any long term follow-up, although some appear to be doing well in the short term. Also on MRI there was a cyst (good size). Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. Thanks so much for your help, very grateful. I saw a surgeon who does the posterior approach only and will see another on 4/14/15 who does both approaches. Even though I was positive I wanted this method done, I was still questioning my decision. Click to enable/disable _ga - Google Analytics Cookie. Upgrade to Patient Pro Medical Professional? Very strange Thank you very much for taking time to reply me. We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. I assume PTHR is referring to partial hip replacement. If you refuse cookies we will remove all set cookies in our domain. 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.) Evidence review for hip replacement approach - NCBI Bookshelf Over the last six years, I have performed more than 2000 primary or first-time total hip replacements using the mini-posterior approach and I am aware of only one patient who dislocated his hip because he fell down stairs. Behavior. What To Expect From Anterior Hip Replacement Surgery & Recovery I try not to bring up my mess but its hard when its with one 24/7. The femur is prepared with the head and neck intact reducing the chance of fracture. Driving hurts too. I had an anterior right hip replacement in late 2010, I was 72. Hip replacement - Wikipedia 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. (a) Components of a total hip replacement; (b) The - ResearchGate I am planning to have a THR this summer. Surgical Approaches in Total Hip Replacement 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. Imagine your femoral head lacking full acetabular coverage, resulting in an overloading of the superior aspect of your socket, hence the cartilage and labrum becoming damaged and ultimately breaking down. If you have an abnormal anatomy or are morbidly obese, you may not be a good candidate. Most doctors have and continue to implant hips through the posterior approach. Additionally, people with certain health conditions such as diabetes or heart disease may also not be good candidates. I have a yr or more off work so I have the time to heal properly but scared to sit or move an Inch as I dont want to dislocate my hip again I dislocated my left hip in a resturant while eating lunch with my 10 yr old we both suffer from ptsd now and stayed in the emergency room for 30 hrs before they rushed me to the city hospital. A hip replacement is the most common cause of complication in about 20% of cases. These positions include crossing your legs, bending your hip more than 90 degrees, or lying on your stomach. Its reasonable to inquire about his or her experience using the Mako robot. Thanks. 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. Does this mean my body may reject the metal of the post or cup? It is difficult to get that from information which I find curious. Thanks again for this great blog! I prefer spinal anesthesia when possible because fewer drugs are used and often the experience is gentler. The earlier the recovery begins, the better chance for a more-complete recovery. This does not necessarily mean they will have more pain or take longer to get well. Specific protocols, therapy and what positions you will be asked to avoid after surgery and for how long will be directed by your surgeon. Also, if a surgeon knows in advance that a certain range of motion is desired, can they provide some adjustment in surgery to help accommodate that desired movement? Im sorry to hear that you struggled after your first, anterior-approach THR. If this occurs, the patient usually requires a total hip replacement. Dear Dr. Leone, I still maintain that by far the most important decision patients must make is choosing the surgeon who will do their surgery and take care of them, then trusting that individual to choose the approach, prosthesis and make a million other decisions that deliver as perfect a result as possible. THR - Posterior or Superpath Decision - Joint Replacement Patient Forum Im sorry to learn that you are so disappointed with your hip replacement. Hip pain, soreness, and stiffness can quickly become unbearable and sideline us from the things we enjoy the most. Intervals between muscles are separated or muscles are separated in line with their fibers without injuring the muscles innervation. Which approach did the doctor take? My question is: should I just tolerate the pain and limp, or take a chance with the hip replacement. Hi, I now need the right hip replaced. You can resume your active lifestyle as soon as possible thanks to a new prosthetic hip. I absolutely would not insist on minimally invasive surgery and a small incision, especially considering your mom is short, obese and has osteoporosis. What is most important is that the surgery is expertly done, that the tissues are not brutalized, and that the surgeon can see what he or she is doing. 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. Achieving legs that feel equal in length after surgery is imperative. Being cared for in a hospital that specializes in joint replacement and has an extensive specialty medical staff also is key. Comparison of short-term outcomes between SuperPATH approach and Posterior, mini posterior or anterior? Patient is a UK registered trade mark. I thought the newer procedure on the special table was the best way to go. For many years, I performed bilateral THR and bilateral TKR procedures, but have backed away for a variety of reasons. Hi Frances, did you have surgery posterior Superpath? Apples to apples which procedure has the lowest incident of complications? Most patients after a bilateral procedure would not go home but rather a rehab unit. 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.. J. Dear Dr. Leone, Having a hip replacement using SuperPath keyhole surgery Will I still be able to do all of these things? He also used the term anterolateral. 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. It's what compelled me to seek out different methods and post here.. You will find the surgeons will all give the pros but never the cons what ever the method. You are to be commended for taking the time to answer our questions. I wish you well. J Orthop Surg Res. Not sure exactly what that means. Does the mini posterior hip replacement conserve more femur and allow for future surgeries if needed ? A recent article published by the Journal of Bone and Joint Surgery has demonstrated that the direct anterior hip replacement has more blood loss, a higher risk of intraoperative fractures, an overall higher complication rate and no difference in outcomes versus other techniques. Blog I furniture surfed in the house and used a stick outside.I was hopeless with crutches, but I think it is recommended we should use them, particularly to ensure we don't get a limp and build our leg up properly. I was released to go back to work after only 10 days. It is a mix of anterior & posterior. In my practice, I cement an Exeter stem in a significant percentage of my patients who undergo THR . Cons of Robotic Assisted Surgery As with any type of procedure, Mako is not without its drawbacks. posterior surgery . Robert H. Sigmund, MD | Signature Orthopedics The most common type of total hip replacement is done in the anterior anterior part of the hip. The SuperPATH technique is arguably the least invasive hip replacement technique. SUPERPATH Hip Replacement | Bethesda Orthopaedic Institute In 2010, more than 310,000 hip replacements were performed in the United States. Mar 13, 2013. It is 100 percent normal and expected to be scared before surgery. It seems that whatever their particular approach is that is what they sell. I plan to retire from working full time June 2017 and am concerned about having appropriate insurance after that. If youve had a failed hip arthroscopy, almost certainly you also have acetabular pathology and a total hip rather than a partial hip replacement may give you a more consistent, longer-lasting and more perfect result. Hip replacement is the second most common type of joint replacement, trailing only total knee replacement. The first is that it is a major surgery, so there is a risk of complications such as infection. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. My two questions are: 1. SuperPath Hip Replacement (Surgery) : 3D Animation - YouTube I am suffering from a severe range of motion where I cant put my left sock on or tie my left shoe, I can barely get in and out of low cars and sitting up at a table hurts too! Its from a malformation. Ten out of every fifteen hip replacements will be functional for more than 20 years after they are inserted. I would not anticipate them improving with time, but rather worsening, and I cant imagine you being able to resume the activities you described without having surgery to treat this. Share your concerns with your surgeon. Iliotibial (IT band) damage, had 2 months of ART release work on this issue. Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer. My first bike ride was 22 miles without any problems. Can I expect any problems with the bilateral it was my choice. It is important to consider the SuperpathTM technique if you are considering a hip replacement. My main concern is that I have a tilted sacrum and a very sway back. Sometimes, it simply isnt possible to accomplish. Do you agree? If you do not have a hip replacement, you will live a sedentary lifestyle and become overweight. Will I be able to dance, hike, bike, swim, exercise after a 3rd surgery? 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. When the anterior approach is used, the soft tissues in the hip stay intact, allowing for better hip alignment. 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). 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. I am thoroughly confused at this point. I have seen a number of patients who were reconstructed with the anterior approach who developed painful anterior scarring after the procedure.