I have linked back to several blog posts below that will give you more in-depth information. One disadvantage to the mini posterior approach is that patients are instructed not to place the newly implanted leg in certain positions for the first six weeks after surgery. THR if a MRI or Pet Scan isnt done? There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. J Bone Joint Surg Am. My surgeon has told me I will need PT 3 times a week for 6-12 weeks is this too long? The experiences will vary greatly . invasive posterior vs not so good with AMIS) whilst on the other hand, with one of your replies you state that surgeon experience should be considered with AMIS success rates and in other replies stating that both alternatives are good. I would emphasize choosing your surgeon and not the approach. Both of these are very successful ways of doing a hip replacement. Tina, which procedure did you have? Hip replacement via SuperPATH approach had a longer operation time than hip replacement via conventional approaches. Reconstructing the opposite hip hopefully will result in legs that feel more equal. My advice is to consult with your surgeon regarding how stable the replaced hip is and the most appropriate rehab to follow post-operatively. The first is that it is a major surgery, so there is a risk of complications such as infection. Should I be though? I live in Staten Island and need rt hip replacement. 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. 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. [QxMD MEDLINE Link]. It is also possible to have an anterior hip replacement during pregnancy. results, I decided to see and orthopedic doctor was advised to have THR. My mom is obese, short and has osteoporosis. Fax: 954-489-4584 The vast majority of my patients return to work one to three weeks post-operatively. Thank you for sharing with others the nerve supplements that youre finding affective. Country. posterior surgery . Getting in and out of cars, and turning over in bed. Similarly, an engaged medical team needs to be available to help with care after surgery. Can You Use An Inversion Table With A Hip Replacement 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. Having physio A major hip replacement can take up to four months to fully recover from. The pain is really inconsistent, one min I will be walking fine and the next it catches and is very painful, then it may go away or may not. These positions include crossing your legs, bending your hip more than 90 degrees, or lying on your stomach. Is THR something that can help? I encourage you to do the same. There is no way that you can recover fast from having bones cut and shaped and large metal objects inserted into them. That's all I know. I wish you a full and speedy recovery. Lastly, if one has had P or AL is there anything that can be done to offset the need for restricitons? Driving hurts too. I went in with high expectations of coming out so much better off and here I am 5 yrs out limping more than ever and a NUMB thigh and worse knee and weak ankle. Thank you for all you do and for providing me with the information when I needed it. Really Great. 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. A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). Im considering this mini posterior approach. There is also a small risk of infection at the surgical site. Are my findings that posterior approach in my situation would have been more appropriate? I am sure you should not listen to what I did!! There are many factors that contribute to whether or not someone is a good candidate for anterior hip replacement surgery. Further, I would contact your insurance carrier and the hospital so you will not be surprised with any unexpected costs. An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. Some surgeons will use 2 incisions, both the anterior and superior approach. Once youve decided, you then need to trust that he or she will take the best care of you possible to deliver the best results. Spring 2014 had trouble playing tennis, hip kept feeling like it was popping out of joint, groin pain, aching. If possible, speak with other health professionals who work at the hospital or at least in the same geographical area. It is much better to precisely release and cut rather than tear or fracture. I wrote to you in January, now my surgery is in a couple of weeks. You are free to opt out any time or opt in for other cookies to get a better experience. 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. 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. It is critical at time of surgery that an excellent range of motion be created without impingement. 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. Additionally, people with certain health conditions such as diabetes or heart disease may also not be good candidates. It is highly recommended that you avoid bending your hips and turning your feet together as part of hip precautions. I believe a THR will benefit you tremendously. Brandon Callahan, MD is a board-certified orthopedic physician with a decade of experience in providing comprehensive orthopedic care to patients with musculoskeletal injuries and disorders. Most THR patients do not need significant supervised physical therapy after surgery; they simply do well when their surgery is done well. Following anterior hip replacement surgery, avoid soaking in hot tub, sauna, or swimming pool immediately after surgery. Thank you so much for your answer, I appreciate your taking the time to care about others. There is a chance that the hip will fall out of the socket, or that it will be levered out by twisting it. I am thoroughly confused at this point. Clearly, he or she has earned your respect and confidence. These can include damage to blood vessels or nerves, dislocation of the hip, and infection. There are a few disadvantages to hip replacement surgery. This allows you to resume normal daily activities quickly while also returning to normal range of motion and function. SuperPath is a portal assisted THA approach that accesses the capsule superiorly through the interval between the gluteus medius and piriformis without requiring the cutting of any muscles or tendons. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. We need 2 cookies to store this setting. I, personally, have not had a patient dislocate following a primary total hip replacement in many years. There are various ways of doing a hip replacement. When it comes to hip replacement surgery, the surgeons skill, the patients weight and build, and the surgeons level of experience all have an impact. Gililand, our physician, explained the concept of health. Pain Management I have read your articles about procedures (anterior vs posterior). Some patients who have recently had anterior hip replacement may suffer from complications such as wound healing. We want the forums to be a useful resource for our users but it is important to remember that the forums are My two questions are: 1. An anterior capsule is the only soft tissue cut during this procedure to insert the implants. I think they are happier and rehab more quickly. I was told the joint lubricant had migrated into the hip bone creating the cyst, There is effusion in the joint and stress areas. but it was more torn than they thought and they had to cut out about 1/4 of it. Adductors refer to a group of muscles that insert into the medial (inner) upper femur and often become contracted with an arthritic hip. 2. Nerve regeneration can occur up to 18 months following injury, but the chance of full recovery decreases with delay in recovery time. If you do not have a hip replacement, you will live a sedentary lifestyle and become overweight. I would like your opinion. Dr Leone, you make the point several times that the surgeon, not the procedure is most important. You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. I wish you the best of luck. 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. 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. #1. In general, if someone is dedicated to the job, the return is very quick. 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. I am totally confused and dont know which procedure to choose. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. This robotic technique can assist in producing an excellent result. Its been a nightmare for me going into 4 yrs post op soon. I would look at the published track record of the hospital where the surgery is scheduled to be sure its performance record is good and its incidence of infection is low. Because of the marked improvement in modern plastics, there is greater longevity and durability of acetabular plastic liners and larger femoral heads are used routinely which results in an improved the head/neck ratio and therefore the jumping distance for a hip to dislocate. No i just had the posterior method which has a larger incision. This is actually a good sign. Although anterior approaches can be useful for some, they are not for everyone. If your surgeon cant answer your questions about hip replacement or provides unsatisfactory answers, you may need to consult another surgeon. Both problems are on the right side of my body. Ill know a lot more after we meet and I review your X-rays. Enhanced soft tissue techniques also have been developed which more securely close the tissue around the newly placed prosthesis and set the stage for healing. The hip joint needs to be replaced again when it no longer works properly because of a revision surgery. He treats a variety of hip, knee, and shoulder conditions, and performs hip and knee total joint replacements. Remember, what youre hoping to do is have a hip construct that will last 20 years or more. 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. His hip ball was put back in the socket and he has done beautifully since. Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. I typically do hip replacement on the get anterior approach in 90% of my patients. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures.A total hip replacement (total hip arthroplasty or THA . However, I now have quite severe OA in my right hip apparently I have no cartilage left and have been told by a surgeon that I am just lucky not to be in constant pain. I would research and find the physician and hospital that will give you the best chance of doing well. Fortunately, if the components are stable (bone-in grown or cemented) and optimally positioned, and the surrounding tissues has fully healed and matured, then that risk is very small. Honestly, most 59-year-old active women do best with a well done THR. I recently had a spontaneous hip fx and was diagnosed with hip displasia. It is a pity that medicine cannot be as definitive as science but relies on historic figures and the future outcome appears to be a statistical probability! I wish you luck on your journey. A typical recovery time from anterior hip surgery is six months. Yes, you do have increase risks. Part of those possibilities includes a better and more comfortable sex life. It is difficult to get that from information which I find curious. Since then, SuperPATH has enjoyed excellent success. I also regularly receive Rolfing treatments which has helped me manage pain and maintain what mobility I have. From what Ive seen, most THR patients dont need very much PT, although I do encourage exercising in a pool. The surgical area of anterior hip replacement is located in the vicinity of the lateral cutaneous femoral nerve. I have had both hips replaced about 13 months apart, one anterior and one posterior, and there is no doubt that I would recommend anterior. Also, because technically it is easier, many patients are being reconstructed with very short stems which are press fit into the bone during an anterior approach. Sometimes, it simply isnt possible to accomplish. So im going back to the surgeon that did my left hip and left me in agonizing pain for 2 months after procedure. disadvantages of superpath hip replacement. The hope is that these new designs will, but time will tell. Prior to surgery, you need to be evaluated by your primary care doctor and any other specialist who helps manage your care, so the conditions you have can be optimized. Thanks again for this great blog! My recommendation is for you to discuss this with your surgeon if you have further concerns. Having diabetes and two organ transplants does significantly increase your risk for post-op infection as well as other complications. The only problem Ive had post hip replacement is some on/off again groin pain. There has been an increase in the range of motion. Sitting seems to irritate it the most. Our insurance covers both. At the end of the day, I promise, it is not the approach but rather the person who is doing the surgery. Historically in my practice I performed many Bilateral THR and TKR and have backed away from that practice. These stems are a new design, and therefore do not have an established track record. Two which are receiving the most attention are the traditional posterior approach and the direct anterior approach. You are to be commended for taking the time to answer our questions. (Of course, I do.) No groin pain NOW.but all the other mess of it all. No Muscles Cut is for billboards. A hospital outpatient surgery can cost between one-third and one-half the cost of an outpatient surgery atCOSC. I am wondering if having mild hip dysplasia is a factor in which approach is used. Dear Mary, Thigh feels so Heavy and I massage that area a lot. To have your other hip replaced through a different approach is a decision you need to make with your surgeon. Because my husband has circulation problems in his leg and vein removed for open heart surgery last yearhis surgeon recommended the Mini posterior surgery. Overall, however, anterior hip replacement is a safe and effective procedure with a high success rate. Dr. William Leone. I have not seen this before because in the past, the complication from hip surgery were sciatic nerve injury from posterior approach. 2 x week. If this occurs, the patient may experience pain and swelling. Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. The incidence of dislocations has further decreased over the past decade with our ability to implant larger size femoral heads. I was out of bed walking around the evening of the surgery . In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. Testimonials The last page is asking the participant to self score their health that day out of 100. He is the founder and main author of brandonorthopedics.com, a website that offers valuable resources, tips, and advice for patients looking to learn more about orthopedic treatments and physiotherapy. My worry is that I will end up with one leg shorter than the other. 1. Dear Dr. Leone, The surgeon I am meeting with (Dr Jimmy Chow) is supposed to be top notch in this procedure, and I am just curious as to how different the surgery is from conventional surgeries. I am 56 now and find that physical therapy and chiropractic care dont seem to be helping anymore. Cons of Robotic Assisted Surgery As with any type of procedure, Mako is not without its drawbacks. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. 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. That being said, you should have the additional surgery where you feel you will have the best chance of doing well. Before proceeding, it is a good idea to review the recommendations and specific parts that your surgeon may recommend. Thank you. Often, as the labrum is torn, it leads to a lifting off of hyaline articular cartilage where these two tissues meet, called delamination. Patients are typi. Registered in England and Wales. Consuming excessive-fibre and wholegrain meals will assist to keep you feeling full, and will be Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. In general, people who are older, heavier, or more active may not be good candidates for this type of surgery. It also helps to stabilize the acetabular shell and prevent soft tissue irritation on the out edge of the cup. I will reiterate what I know to be true. Hip replacement is a fantastic operation that can help relieve pain, improve daily function, and improve quality of life. Finally, many people who are struggling with hip disease experience lower back pain or even sciatic discomfort. I wish you a full and speedy recovery. 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. Most patients are able to walk the day of surgery. 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. The amount of PT you need after surgery will be determined by you and your surgeon. Surgeons do not cut across muscles. In comparison to traditional methods, anterior approaches to the hip joint are more effective. This treatment is commonly recommended for patients suffering from osteoarthritis of the hip. 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. It is important that the individual who ultimately implants your next THR uses the approach which he or she feels comfortable with and has the best chance to deliver the optimal result. I am looking at how many hips they have done and where they are doing them. Thank you. Once again, I think your decision to proceed with THR is the most reasonable. Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. and Privacy Policy and steps will be taken to remove posts identified In the United States, a traditional posterior approach is the most commonly used. Since these providers may collect personal data like your IP address we allow you to block them here. So my concerns include having the range of motion to perform moves like promenade where my body is roughly facing forward and my right leg will take a step left across my body at about 90 degrees. Fitness going into surgery and speed of recovery seems to be a common theme though. I think its vitally important that you go into surgery truly believing in your heart that you are going to do well, and that you are with the best surgeon and team who will help you. I am a sixty five year old active male and need THR on my right hip. Historically, higher dislocation rates were reported with the posterior approach, but it still was used for its many other advantages. I love that you take time off to reply to these messages it is commendable. 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? In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. I would then let that person decide with what approach they think they can best accomplish the surgery and deliver the best result. This often leads to a less than optimal component position. Because the patient is lying on his back, it facilitates using a fluoroscope or moving x-ray throughout the procedure. Surgery carries increased risks because of these conditions, but by defining the risks and optimizing any underlying conditions, the risks can be minimized and hopefully managed. 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. I also would find out your surgeons recommendation regarding activities and restrictions. Click to enable/disable _gid - Google Analytics Cookie. Dear Doctor Leone, A less stringent set of precautions is required with the anterior approach. Depending on the stability and range of motion observed at time of surgery, some doctors dont advise their patients to avoid any positions. Also, the choice of femoral stem is more likely to be influenced by the approach and not the persons anatomy and hip mechanics. What is SuperPath hip replacement? 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. I had to cut some strength exercises out leg lifts, hip sled. My doc said the angle of my hips is not the worst but also not the best. I live in the UK so again Im afraid I wont be able to consult you personally! Egton Medical Information Systems Limited. I still have a very big limp and still undergoing physical therapy. It is not acceptable to lean forward while sitting down or standing up, and it is not acceptable to bend past 90 degrees (as shown in the angle in the letter L). 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. I am so sorry to learn that you are struggling. 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 am so sorry to learn that you have had such a bad experience after THR. Is the hospital where the surgery will be performed also top rated?. I'm scheduled for THR on the 22nd. I take care of many individuals who have a total knee and hip replacements on the same side. 2023 Brandon Orthopedics | All Right Reserved, hip replacement pain reduction surgery patients, The Best Sneakers For Hip Replacement Patients, Anterior Hip Replacement Surgery: The Pros And Cons, The Truth About Spinal Stenosis: Causes Symptoms And Treatments, Can Years Of Surfing Contribute To Spinal Stenosis, The Effects Of Spinal Stenosis And Carpal Tunnel, Should I Apply Ice Or Heat To A Compression Fracture, How Does A Soft Bed Prevent Healing Of Herniated Disc, Herniated Discs: How To Sleep Without Worrying About Rupturing Your Discs, If You Have A Herniated Disc You Know The Excruciating Pain It Can Cause. 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! An anterior hip replacement is, in many ways, less risky than any other type of hip replacement. Its been 9 months(Ive had it 2xs bf and got rid of it and have tried everything and no results this time). Also available today are larger modular heads, made possible because our plastics are so much better than years prior. I would avoid the metal-on-metal articulation. Finally, because my patients are walking the day of surgery, most want to go home rather than to rehab. Results of the surgery numbness in the right thigh, inability to stand on the right leg, muscle atrophy all confirmed by EMG and second orthopedic surgeon. I am deciding that my quality of life is in the toilet and need to get the THR done. Every prosthetic joint has a mechanical range of motion. The pain I get is in the groin and a sharp pain in the buttocks, that feels like muscle pain.

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