As a result of this precaution, it is difficult to sit on low chairs, sofas, or toilets. We thank you for your readership. The anterior approach has a lower incidence of sciatic nerve injury and a higher incidence of femoral nerve injury. Depending on the stability and range of motion observed at time of surgery, some doctors dont advise their patients to avoid any positions. I would like your opinion. A hip replacement is the most common cause of complication in about 20% of cases. I would recommend having an honest discussion with the surgeons you are considering. It will help desensitize and help get your muscles working in synchrony. 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. Mar 13, 2013. There is also a small risk of death associated with any surgery. Im pleased that you will be coming in for an appointment. Because I have scfe also in my left hip, I will have to have it fixed too. I, too, am struggling which approach to have. In my experience, there is a faster and more-consistent recovery with the mini-posterior. I wish you luck on your journey. I am so sorry to learn that you are struggling. I dont think there is one best prosthetic. Some have features that are more suited to one persons anatomy and needs than others. Patient does not provide medical advice, diagnosis or treatment. In 2014 I had to do another THA, this time on my right side. 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. 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.) The pain I get is in the groin and a sharp pain in the buttocks, that feels like muscle pain. I assume its something near my groin. SuperPath approach uses about a 3-inch incision at the side of . I love that you take time off to reply to these messages it is commendable. With SuperPath, there is no surgical dislocation of the hip. If you refuse cookies we will remove all set cookies in our domain. Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. Recognize that the underlying etiology is not being corrected by this procedure, so relief of symptoms probably will be temporary and possibly partial. I never seem to know when I am going to get hit with pain. I suggest you discuss your concerns with your surgeon. This is described as a posterior approach because the actual hip . Remain upright . We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. Specific protocols, therapy and what positions you will be asked to avoid after surgery and for how long will be directed by your surgeon. more nutritious, too. As long as you do the necessary surgeries, you will eventually break your femur, but only if you do enough. Personally, I would not gamble with my health. The initial recovery period typically takes six weeks or more. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. I went with a total hip replacement. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. The rule of thumb is that recovery occurs over a 12-18 month period following injury. Uncemented. Dr. William Leone, Hello Dr. Its from a malformation. J. Dear Dr. Leone, 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. If you have these arthritis symptoms, you should consider a hip replacement: severe hip pain that is not relieved by medication and that interferes with your work, sleep or everyday activity hip stiffness that restricts motion and makes it difficult to walk To learn more, read Here's What to Know if You Think You Need a Hip Replacement. Click to enable/disable essential site cookies. Should I look to another approach and surgeon? The surgeon I went to said he does THR using a lateral approach. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. The femur is prepared with the head and neck intact reducing the chance of fracture. If possible and a pool available, I encourage my patients to walk and exercise in a pool and / or swim, starting at two weeks when their suture is removed. I was told to wait 6 weeks before I resumed my exercise regiment. 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 . Call (919) 781-5600 to find out if you need total shoulder replacement in Raleigh, Cary, North Raleigh, Garner, or Holly Springs. 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. Posterior, mini posterior or anterior? My right leg is already a bit longer than the left. With the ease of movements during pregnancy, you will be able to move around more freely. 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. Do you also do arthroscope surgery? This is actually a good sign. 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. 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 am 56 now and find that physical therapy and chiropractic care dont seem to be helping anymore. We may request cookies to be set on your device. 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. 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. i had lateral posterior, my surgeon stopped doing anterior because he said it caused muscle problems moving them about and can also cause nerve damage, which is the main reason I did not want that approach. I just saw a patient with a femoral neuropraxia after a anterior approach THR. Risks associated with hip replacement surgery can include: Blood clots. It turned out to be more torn than they thought and they had to cut about a forth of it out. It is 100 percent normal and expected to be scared before surgery. 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? 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. Ive done PT and plan to continue working on strengthening my core and flexibility of those large muscles. Will I be able to dance, hike, bike, swim, exercise after a 3rd surgery? Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. posterior surgery . I really appreciate this website. Patients who are significantly overweight (I specifically assess the amount of tissue between the skin overlying the lateral hip and the greater trochanter), who have significant long-standing contractures and restricted ROM, congenital dislocation, and marked acetabular protrusion (when the femoral head wears centrally into the acetabulum) typically require a larger incision and more soft tissue releases. Due to security reasons we are not able to show or modify cookies from other domains. Here is his perspective based on careful observation of outcomes. The SUPERPATH technique is a tissue-sparing procedure. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. You are free to opt out any time or opt in for other cookies to get a better experience. Total hip replacement is one of the most successful operations ever developed and is a remarkably predictable way to relieve pain from arthritic conditions. as being in breach of those terms. Most THR patients do not need significant supervised physical therapy after surgery; they simply do well when their surgery is done well. This can cause you persistent pain, stiffness . It is critical that the patient is aware of the risks, benefits, and alternatives of the procedure. I am Australian so no business from me but it has helped me become happier with my prospective surgeons judgement that he will offer me a posterior THR (hopefully the minimally invasive) when my insurance allows the procedure to occur. If your little voice is questioning if you are overdoing it or hurting yourself, then listen to it and ease up. surgeons certainly do not go out of their way to cut anything, they move stuff about, if tendons do get damaged, it's more likely from the anterior approach as they have less 'sight' of the procedure due to the smaller incision. My question is: should I just tolerate the pain and limp, or take a chance with the hip replacement. My second question relates to something you mentioned earlier regarding checking the published track record of the surgical team if I use an HMO, how do I find that information, and how do I know it hasnt been skewed to give more favorable results (lying with statistics)? If they are really happy, then you probably will be as well. Hello Dr Leone, I have not seen this before because in the past, the complication from hip surgery were sciatic nerve injury from posterior approach. Also on MRI there was a cyst (good size). Less tissue damage during surgery allows for a much faster recovery and no restrictions in range of motion when compared to traditional hip surgery. Lastly, where can I find a great surgeon that takes FL Workmans Comp? Will meet with doctor soon but when I was finally able to really exercise after surgery I overdid it and developed plantar fasciitis. Obese or extremely muscular people may not be the best candidates for this surgical procedure. A mini posterior approach is a modification of the classical posterior approach. I typically do hip replacement on the get anterior approach in 90% of my patients. Advantages of an anterior approach to hip replacement A major muscle is not cut during the anterior procedure. What are the risks involved? The mini posterior approach works wonderfully and predictably when expertly performed. 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. When discussing the options, my surgeon all of a sudden suggested performing anterior approach. Nerve regeneration can occur up to 18 months following injury, but the chance of full recovery decreases with delay in recovery time. The surgeon I saw said that my body structure and gait does not affect which approach would be ideal for my body. 4. I would rather see my patients go home. 3. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. 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. I understand that most surgeons now do a spinal rather than general anesthesia. I know the most important decision you will make is choosing the doctor who will perform your surgery. Time will tell if this generation of shorter press-fit stems fares as well. Testimonials My surgeon wants to use the posterior approach and indicates that I eventually should be able to play golf again. [QxMD MEDLINE Link]. I have had problems with my hip for the last several yrs. 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. Always speak to your doctor before acting and in cases of emergency seek SuperPATH showed better results in decreasing operation time, incision length, intraoperative blood loss, and early pain intensity. Some patients who have recently had anterior hip replacement may suffer from complications such as wound healing. 2012 Oct 17;94(20):1897-905. doi: 10.2106/JBJS.K . I, personally, have not had a patient dislocate following a primary total hip replacement in many years. Also, in the U.S., nearly all stems which are being implanted through the anterior approach are press-fit rather than cemented. 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. In the right hands, both approaches do great. Hip pain, soreness, and stiffness can quickly become unbearable and sideline us from the things we enjoy the most. It is highly recommended that you avoid bending your hips and turning your feet together as part of hip precautions. Patients are typi. Hip replacement currently consists of two major approaches: direct anterior and anterior approaches. 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. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. The first is that it is a major surgery, so there is a risk of complications such as infection. Once it exceeds this ROM, impingement occurs. I do not do hip arthroscopy. According to Dr. Rosen, the most important thing to remember is what you leave behind rather than how you get there. By adhering to the surgeons instructions as well as their pre- and post-operative instructions, you can reduce your chances of complications. I have linked back to several blog posts below that will give you more in-depth information. There are a number of different surgical ways (approaches) to access the hip joint. Just getting your thoughts I will discuss it more with my surgeon at the pre-op meeting. 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. Doc, Ive worked out and been physically active forever running, biking, skating, etc. Thank you for sharing. The surgeon does about 200 a year and people say he has a good reputation. Rather, they say Bill, please just do what you have to do and do a great job. 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 try not to let it get to me, but it causing me to feel handicapped. I didnt spend time on boards talking for eons about peoples outcomes.probably a good thing I didnt. Hip replacement surgery can open up a world of possibilities for people who have lived with pain and restricted movement. 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. Finally, hip replacement surgery is expensive and may not be covered by insurance. 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. Both approaches have been shown to have potential in research. Further, the extent of dissection is more minimally invasive, which also improves stability. Consult your doctor to determine if joint replacement surgery is right for you. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. Do you have any advice or ballroom dancer THR stories to share? Contact Us, Approaches The SuperPATH technique is arguably the least invasive hip replacement technique. My advice would be to avoid the extremes of any motion that exceed your hips ROM. He is well known as a top doc for 20 yrs & I was persuaded because the mini posterior has less chance of nerve damage & the surgeon has more options for types of spikes, which your article explains well. There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. Why would the doctor not have that at their finger tips? I believe going home is very therapeutic and often safer. Im 51, 59 and 148 and want to get back to tennis etc, this has been long frustrating process. 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! It is critical at time of surgery that an excellent range of motion be created without impingement. 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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