This suggests that something changed after five months. I have insurance with very high deductible and I am scared of the debts I might incur afterwards too ( where I am planning to do it I might not have to pay any money). In a posterior hip replacement, the procedure is done on the side of the hip. I dont think there is one best prosthetic. Some have features that are more suited to one persons anatomy and needs than others. I have seen a number of patients who were reconstructed with the anterior approach who developed painful anterior scarring after the procedure. No i just had the posterior method which has a larger incision. Also congenital pulmonary hypertension (PA pressure about 52) and have hashimotos hypothyroid, and two additional auto immune issues ( alopecia and psoriasis of feet),and hypertension. Types of Hip Replacement (Approach) Hip replacements can be preformed through a direct anterior approach, an anterior lateral approach, a lateral approach, a posterior approach, and a superior approach. However disadvantages include the inability to adjust for leg length differences and a relatively high risk of femoral neck fracture. 10 users are following. As a result of this precaution, it is difficult to sit on low chairs, sofas, or toilets. 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. 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. Rather, they say Bill, please just do what you have to do and do a great job. Third, the procedure is shorter in length and requires less hospital stay than traditional hip replacement surgery. Every . Thank you so much for taking the time to inform us! The first step to rule out infection is to have two simple blood studies done, an ESR and CRP. This does expose the patient to more radiation but can help with component positioning and sizing. Is AL better than P for this? I am now 59, still in good condition but that is being compromised by lack of working out as my hips get sore from most everything I try. Because of the straightforward exposure of the femur, there is less risk of femoral fracture or poor implant positioning. The anterolateral approach or Watson Jones approach is one of the classical hip approaches that can produce excellent results when utilized for THR. Many in business or who own their own businesses will stay home for only one week and then return to their work place because they are bored and would rather be productive and busy. Lift your knee rather than your hip at the same time. I cant find anything that addresses replacing a hip that is dysplastic. In my experience the approach used to replace a hip does not effect how quickly a patient recovers. 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. It is critical at time of surgery that an excellent range of motion be created without impingement. I dont want a long recovery time as I am very active. Most of the restrictions are removed at that time, although I still advise common sense, particularly for the first three or four months. Will I still be able to do the things I like to do? 5 Things to Know About Anterior vs Posterior Hip Replacement Select a surgeon based on your impression of that individual: how engaged was he or she in your care, will you have access to that person as well as his or her team before and after surgery? Problem is that we have seen two doctors and both seem great but are on two extreme sides of the fence. The surgeon I saw said that my body structure and gait does not affect which approach would be ideal for my body. I am a sixty five year old active male and need THR on my right hip. Finally, hip replacement surgery is expensive and may not be covered by insurance. A lot of hospitals and ambulatory surgical centers offer what's called outpatient surgery. I suspect there is significant underlying osteoarthritis related to your labral pathology. 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 now 6 weeks out and doing good. 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. There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. The vast majority of my patients return to work one to three weeks post-operatively. Very sorry to hear of the difficulties you experienced! Dr. Himmelwright Introduces SuperPath to OIP There are numerous complications associated with hip replacement surgery, but blood clots in the legs and hips are two of them. As a result, you are unable to pick up something from the floor or bend down to tie your shoes. I wish you the best of luck, 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 traditional posterior approach is the most commonly used in the United States and throughout the world (about 70 percent). 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. I am a South African and need to make a decision on whether my mother (69) goes for an AMIS or traditional posterior. The risk of revision surgery after a posterior hip replacement is the most serious concern. Ive never foulnd information from any doctor or research-site but that there is always no legs-crossing, no more than 90-degrees (for the most part), and no twisting for anything but full Anterior. My question is: should I just tolerate the pain and limp, or take a chance with the hip replacement. 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. The rule of thumb is that recovery occurs over a 12-18 month period following injury. I read hip dislocation is 28% higher after a revision, is it more then 28% after 2 revisions??? This procedure differs from traditional hip replacements in the following ways: There is no surgical dislocation of the hip. Some patients report that symptoms increase in the not-yet reconstructed hip because of the leg length inequality. The doctor is planning a traditional posterior. Most traditional hip replacement models are metal-on-plastic varieties. Risks of SUPERPATH hip replacement surgery Risks due to the surgery may include (but are not limited to): Pain Bleeding Infection Permanent or temporary nerve damage Extra bone or tissue damage Drop in blood pressure during the procedure Leg deformity Blood clot or clots (that could travel to heart or lungs) Delayed wound healing We can do this because of improved plastics. Should one of these events occur during a mini-posterior procedure, they are easier to recognize and correct. I would also like to know about the customized implant, as I havent yet heard much about it. Im hoping to play tennis, go dancing and horseback riding once Ive healed. Traditional hip replacement surgery is no longer an option, but it is less painful and has a number of advantages. Patients mobilize the day of surgery and typically go home the next day. This technique is also referred to as the . J Bone Joint Surg Am. THR if a MRI or Pet Scan isnt done? 5. Im pleased that you will be coming in for an appointment. I am feeling like this is a business like everything is else. I needed no physical therapy at all. Typically, most are eager to go home the very next day; many have already progressed to a cane, which they will not use very long. The doctor used the posterior procedure. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. Orthop Clin North Am. What is most important is choosing your surgeon. Others continue to follow traditional guidelines. Just because hardware in your foot needed to be removed after repairing what sounds like a calcaneal (heel) fracture, absolutely does not mean that your body rejected the metal / hardware or that your body will reject the prosthesis your surgeon will implant to reconstruct your hip. Over the years, these precautions and the length of time to adhere to these limits have been challenged both by clinicians and patients. I try not to bring up my mess but its hard when its with one 24/7. Infection. The SuperPATH technique is arguably the least invasive hip replacement technique. I am female and I weigh 115 pounds. I would discuss fully your goals and concerns. Or are x-rays definitive for determining the exact reason for THR? You are to be commended for taking the time to answer our questions. Does this mean my body may reject the metal of the post or cup? This most often leaves the patient with an area of decreased or uncomfortable sensation or numbness over the anterolateral thigh (top, outside area of the thigh), not the entire thigh. There are a number of different potential surgical approaches available for hip replacement, each with their own potential advantages and potential drawbacks. Email us. It is a mix of anterior & posterior. Often, as the labrum is torn, it leads to a lifting off of hyaline articular cartilage where these two tissues meet, called delamination. Dear Dr. Leone, I am having Makoplasty ( robotic imaging) to my right hip in February. I really appreciate this website. 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. Hip replacement currently consists of two major approaches: direct anterior and anterior approaches. There always are conditions or circumstances that may predispose one to limp or feel as if their legs are not the same length after surgery, but in my experience this is the exception. Hard-on-hard bearings, such as ceramic-on-ceramic as well as metalon-metal articulations, also resulted in larger femoral heads being implanted. Studying a hospital and physicians track record before you commit is important. The nerve which supplies sensation to the front and side of the thigh is vulnerable. Our overall findings suggested that the short-term outcomes of THA through SuperPATH were superior to DAA. I, too, am struggling which approach to have. If your surgeon did a great job, that is something to respect. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. SuperPath Hip Replacement? | Joint Replacement Patient Forum It all comes down to the surgeons comfort as well as the patients. Every prosthetic joint has a mechanical range of motion. 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. Patients who work for themselves are very motivated to return to work and often do so between procedures. Since 1995, there has been an extremely low dislocation rate and an infection rate of zero percent. I do not do hip arthroscopy. Hip Replacement | Types, Approach, and Surgical Recovery from publication: Current and . Rush joint replacement surgeons are leaders in hip replacement surgery and research. General comments will be answered in as timely a manner as possible. Total Hip Replacement Surgery | Kaiser Permanente I am just under 5 ft and weigh 185. There is less blood loss with a single THR than a bilateral, hence less risk of needing a transfusion. I will reiterate what I know to be true. Thanks so much for your help, very grateful. 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. If was 3 weeks after discharge The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. 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!" 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. Is a prerequisite for THR to have a MRI or Pet Scan? 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. Being discharged to a rehab unit is now the exception. I wish you the best of luck. Im hearing no restrictions (once recovery is done) for Anterior, but always some for the other two. I just had mine 10/30 all I can say is be patient get lots of rest and take your pain meds way before you start to move around so that the pain want be so bad with movement. I had the posterior approach, the surgeon did not cut any muscle plus I had no pain at all after the op. Click on the different category headings to find out more. 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. I'm scheduled for THR on the 22nd. No, I would not tolerate the pain and immobility, if there is a reasonable way to relieve it. Each surgeon approaches these issues individually. Less tissue damage during surgery allows for a much faster recovery and no restrictions in range of motion when compared to traditional hip surgery. For many years, I performed bilateral THR and bilateral TKR procedures, but have backed away for a variety of reasons. A femoral nerve injury is devastating and is more vulnerable during an anterior approach than with other approaches. Everyone I know that has had both posterior and anterior surgery say not to even consider posterior. The anterior approach is not as muscle sparing as some would argue. 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. 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. Years!! Why is that? I love that you take time off to reply to these messages it is commendable. 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. I believe a THR will benefit you tremendously. The big difference in anterior vs posterior hip replacement is primarily where the incision is made and how long it is. Hips that are out of joint have an anterior hip replacement. Ceramic-on-polyethylene is currently the most popular hip replacement material, representing 50.6% of all hip replacement cases back in 2014. In has been my experience in life that if others are happy and had a good experience then that speaks strongly to me, if I were to do the same thing. He is one of the few surgeons in the U.S. that performs total hip replacement via a superior capsular approach, the most soft tissue-sparing hip replacement available and is an industry educator in the . The vascular supply of your leg must be assessed preoperatively as part of you work-up, but most do very well. Going in for THR in July. It is also important to avoid any sudden movements or twisting motions. Gary. 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. 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. results, I decided to see and orthopedic doctor was advised to have THR. Should I go for this or should I opt for the mini posterior. I never seem to know when I am going to get hit with pain. A less stringent set of precautions is required with the anterior approach. Fewer narcotic medications are administered, resulting in a better overall recovery. 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. That I knew this recovery may take 1-2 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. It does mean the surgeon has lots of room to move about though!! In anterior and posterior surgeries, the outcome is essentially the same a new hip. As a result of anterior hip surgery, there is little need for any special care. I did have numerous blood tests, MRI of knee and hip, total body scan with radio active injection, X-ray knee and hip etc. Will meet with doctor soon but when I was finally able to really exercise after surgery I overdid it and developed plantar fasciitis. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. I definitely would not recommend a hip scope and THR during one anesthetic setting. Fortunately, you have already experienced a THR and have done well. The surgeon accesses the hip joint from the front of the hip, rather than from the back or side. Its interesting that when we critically analyze all the variables that ultimately make up the experience that one person has compared with another, or that one person experiences on one side versus the other, we come to recognize its not so straightforward. All orthopaedic surgery demands a long recovery period. Are my findings that posterior approach in my situation would have been more appropriate? 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!). To have your other hip replaced through a different approach is a decision you need to make with your surgeon. The SuperPATH Hip Replacement: A Novel Less Invasive Radid Recovery With SuperPath, there is no surgical dislocation of the hip. If your X-rays reveal that you already have bone on bone due to osteoarthritis, then you typically dont need either an MRI or Pet Scan, unless another diagnosis is suspected. Can you suggest any pain medication that would not interfere with anti rejection drugs? Thank you for this information. 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. We provide the best cash prices and customer care in the industry. Because visualizing the femur is easier, an experienced surgeon can choose the most appropriate femoral implant rather than just the one that is easiest to implant, taking into account the patients bone quality, activity level and age. Do either of your techniques require the traditional anterior or posterior precautions? 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. Despite the fact that this usually takes two weeks or longer, patients can return to work when they feel completely comfortable. The first is that it is a major surgery, so there is a risk of complications such as infection. Patients understand the risks that metal joints and sockets bring to their long-term health and are moving away from the material. It is important that you find a doctor who is experienced in caring for people with complex issues. We may request cookies to be set on your device. Can you compare/contrast to the other approaches; posterior, mini posterior, anterior? The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. I play in the 50s age group. My advice would be to avoid the extremes of any motion that exceed your hips ROM. The femur is prepared with the head and neck intact reducing the chance of fracture. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. There are several positions to avoid after anterior hip replacement, as they can put unnecessary stress on the new hip joint and lead to dislocation. Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. It seems, however, that at this time point, patients who have received resurfacings do as well or better than similar patients who have received total hip replacements. It requires surgical insight and skill to accomplish. I wish you only the best. Six weeks or longer is the exception. This then becomes a very difficult problem to solve. In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. A major hip replacement can take up to four months to fully recover from. There are many factors that contribute to whether or not someone is a good candidate for anterior hip replacement surgery. I am experiencing pai. I thought the newer procedure on the special table was the best way to go. The same is true for a surgeon who employs the anterior or anterior technique. Just getting your thoughts I will discuss it more with my surgeon at the pre-op meeting. Clots can form in the leg veins after surgery. I had good results into 5th month post op and then everything went downhill. Blood-thinning medications can reduce this risk. Hip Replacement | Rush System An anterior capsule is the only soft tissue cut during this procedure to insert the implants. 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. If a revision were necessary, even more bone must be destroyed to remove it. Click to enable/disable _gid - Google Analytics Cookie. Once you find that doctor, then you need to put your trust in him or her to help you solve this horrible problem so you can return to being active and productive. If, on the other hand, the leg length difference is creating hardship and possibly discomfort in other joints such as the lower back, knee or ankle, I would consider proceeding with contralateral THR sooner rather than later. Return to the work place is an individual decision. According to the meta-analysis, DAA (depressing the anterior hip joint by using a metal rod) is associated with significantly shorter hospitalizations than lateral approaches, as well as increased functional rehabilitation and lower perceived pain during the first few days after surgery. My recommendation is for you to discuss this with your surgeon if you have further concerns. 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). I would suggest seeking out doctors who specialize in hip replacement surgery rather than general orthopedics. (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. 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. 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. If your surgeon cant answer your questions about hip replacement or provides unsatisfactory answers, you may need to consult another surgeon. 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. posterior surgery . SuperPATH or Superior Approach To The Hip In Total Hip Replacement Ken. I think tennis, dancing and horseback riding are fine. I do not have dials and no one seems to know where the neuropathy stems from. Inpatient footage of the patient compilation has been edited out to accommodate hospital rules. More likely, its because ones activity increases after the first THR. 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. When studying the hospital credentials, try and learn how many joint replacements are performed at that hospital each year, their infection rate and their 30-day readmission rate. Thanks for any feedback. There is some concern that this weakens the abductor and leads to a limp. 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. Lazaru P, Marintschev I. I wish you the very best, Its been my experience that patients who go into surgery well informed have a better experience and seem to rehabilitate more quickly.

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