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The information I have gathered seems to indicate the anterior approach is more inherently stable, making precautions unnecessary. How long will my hip replacement last? Having a hip replacement using SuperPath keyhole surgery A number of patients who have undergone this procedure are able to walk unassisted the day after surgery . Typically, the new cup will be medialized to gain coverage and correct the abnormality that lead to your arthritis. After the direct anterior approach, there is generally no hip precautions required, and motion is not restricted. In a very positive way, surgical techniques for both anterior and posterior approaches have evolved wonderfully since your surgery was done 10 years ago. There are a few disadvantages to hip replacement surgery. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. My knee and foot and ankle are messed up too since leg ended up at least 3/4 shorter.I wear a shoe lift, but probably needed it sooner than I realized the shorter issue, My knee is pretty stiff and pain when I walk too much, but I deal with it, it bends good, I sleep good, no pain when I do nothing, so Im working all to do NO knee surgery, This hip was ENOUGH to last a lifetime.. Im 76 and use a lot of supplements to save knee and OA in general..I am looking at other protocols for the knee too.not insurance covered, what else is new.if its good, its out of pocket. My advice is to focus on finding a surgeon with whom you are comfortable and have the best chance of doing well. My doctor does not do mini posterior, therefor I have a 6 incision. Also available today are larger modular heads, made possible because our plastics are so much better than years prior. I was out of bed walking around the evening of the surgery . Why would the doctor not have that at their finger tips? They are encouraged to be very active and most stop using a cane, can drive their cars and are exercising in the pool, just two weeks after surgery. Currently, I seldom do bilateral THRs under a single anesthesia but instead stage the surgeries 2 1/2 to 4 weeks apart, depending on my particular patient and his or her needs and desires. What is SuperPath Hip Replacement? Often, as the labrum is torn, it leads to a lifting off of hyaline articular cartilage where these two tissues meet, called delamination. The most common type of total hip replacement is done in the anterior anterior part of the hip. Had horrible groin pain issues and opted for the antior, I knew of nothing else as I consulted with a surgeon who was trained in anterior. Extensive release of the posterior capsule including . The incidence of dislocations has further decreased over the past decade with our ability to implant larger size femoral heads. 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. This treatment is commonly recommended for patients suffering from osteoarthritis of the hip. Honestly, most 59-year-old active women do best with a well done THR. There is less risk of neurological injury. Changes will take effect once you reload the page. Lazaru P, Marintschev I. Less tissue damage during surgery allows for a much faster recovery and no restrictions in range of motion when compared to traditional hip surgery. Both of these are very successful ways of doing a hip replacement. I wrote to you in January, now my surgery is in a couple of weeks. I do not have dials and no one seems to know where the neuropathy stems from. And does A really have none. Any feedback will be appreciated. Dr. Hip dysplasia is a very common underlying cause of hip osteoarthritis. It is highly recommended that you avoid bending your hips and turning your feet together as part of hip precautions. The size and placement of the incisions will be different. Low-risk anterior approach patients are those who have significant deformities in their proximal femur as a result of previous trauma or dysplasia, or who have previously suffered from acetabular bone fractures. It helps the surgeon implant the acetabular component in a very precise position. 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. Over time, some patients may acquire sensitivity or an allergy to the metal particles produced by the metal ball and socket. I wish you a full and uneventful recovery. After reading your article on disadvantages of anterior approach and also doing extensive online search about this subject, I came to realize that anterior approach was definitely a wrong choice considering my physical build short, muscular, overweight. She provided all kinds of benefits with this approach, as faster recovery, less motion restrictions et.al. I read hip dislocation is 28% higher after a revision, is it more then 28% after 2 revisions??? Historically, higher dislocation rates were reported with the posterior approach, but it still was used for its many other advantages. I think it perfectly ok to discuss different approaches and ask for an opinion. Traditional hip replacement surgery is no longer an option, but it is less painful and has a number of advantages. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. For example, the stability of the components could have been achieved initially, but then proved inadequate so you developed either a loose cup and/or a loose stem. Hip Resurfacing vs Total Hip Replacement - sosbones.com Thank you so much for taking the time to inform us! Do you have any advice or ballroom dancer THR stories to share? The last page is asking the participant to self score their health that day out of 100. Im so pleased to learn that you had a good experience. Hey, thanks for the forum topic.Thanks Again. Total Hip Replacement Surgery | Kaiser Permanente William Leone. I am so sorry to learn that you are struggling. I have a tilted sacrum, sway back and a very large posterior. A miniposterior approach uses the same intervals as the standard posterior approach but simply less tissue is released for the exposure. I try not to let it get to me, but it causing me to feel handicapped. 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. Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. 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. It seems that whatever their particular approach is that is what they sell. The impingement can be between the metal neck of the stem and edge of the cup or between soft tissues. 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. The femoral prosthesis is inserted into the hollow part of the femoral shaft. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. 3. About how much does this cost? The Disadvantages Of Anterior Hip Replacement I had good results into 5th month post op and then everything went downhill. I had the posterior approach, the surgeon did not cut any muscle plus I had no pain at all after the op. The SUPERPATH hip replacement is a new technique using superior capsulotomy that allows for implantation of the total hip components under direct vision through a single incision. I am totally confused and dont know which procedure to choose. Get Directions, Phone: 954-489-4575 Can You Use An Inversion Table With A Hip Replacement Does the mini posterior hip replacement conserve more femur and allow for future surgeries if needed ? 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. In general, people who are older, heavier, or more active may not be good candidates for this type of surgery. Did you have the surgery via Superpath method? Had arthroscopy in Jan 15, cleaned up tear and arthritis. Sitting seems to irritate it the most. Some of the most common considerations are age, weight, activity level, and the presence of other health conditions. Anterior hip replacement is a type of hip replacement surgery. Dear DR Leone, During the procedure, the patient must have a small incision made in the side of his hip. What are the risks involved? Thank you, Lisa. What is the best hip replacement option: anterior or Posterior? Thank you, These can include damage to blood vessels or nerves, dislocation of the hip, and infection. I understand and respect that many surgeons prefer doing them simultaneously. I am very athletic and active even with many years of pain from bone on bone arthritis so I am worried about restrictions since Ill probably forget or something. The mini-posterior approach involves separating the muscle fibers of the large buttock muscle located at the side and the back of the hip. But after reading your articles, I am hesitant about that choice now. Can you explain it to me as he didnt go into detail. 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. not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in Hip replacements might keep you out of action for a considerable period. Yes, Im angry. Following anterior hip replacement surgery, avoid soaking in hot tub, sauna, or swimming pool immediately after surgery. Pros and Cons of Hip Replacement Surgery | IBJI Do I have a high percentage of hip dislocation after a 2nd revision done posterior way if so what is my chance of another hip dislocation even if I do the surgery again? SuperPath Hip Replacement? | Joint Replacement Patient Forum If possible, try to get in writing any verbal promises made. SuperPATH or Superior Approach To The Hip In Total Hip Replacement Thru X-rays Ive been told both hips are bone on bone! This procedure differs from traditional hip replacements in the following ways: There is no surgical dislocation of the hip. The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior https://holycrossleonecenter.com/wp-content/uploads/2018/12/Screen-Shot-2018-12-10-at-3.48.24-PM.png, https://holycrossleonecenter.com///wp-content/uploads/2017/11/Leone-Center-Logo@2x.png, The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior and Direct Anterior, Copyright 2018 - 2023 The Leone Center for Orthopedic Care. Thank you. 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. The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. SuperPath experiences good or bad | Hip Replacement - Patient Should one of these events occur during a mini-posterior procedure, they are easier to recognize and correct. Here are a few of the advantages of anterior hip replacement. Personally, I would not gamble with my health. Individual results and activity levels after surgery vary and depend on many factors including age, weight and prior activity level. My question is, I am a very active 67 yr old. 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.. 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 . This can cause you persistent pain, stiffness . Although Superpath hip replacement is often a safe treatment, it may be associated with certain concerns, such as increased postoperative pain, as with any surgical procedure. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. They are addictive, can cause depression, their analgesic effects are short lived and if the condition persists, you will require an increasingly higher dose to relieve the pain. I didnt spend time on boards talking for eons about peoples outcomes.probably a good thing I didnt. 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. I am female and I weigh 115 pounds. Though the duration of your hospital stay can vary, many patients having hip replacement surgery don't need to stay in the hospital very long. I think the money you spend to have a hip replacement is more than just moral or justified, it is smart business. After all, no matter the age, it will determine the likelihood of maintaining your mobility and independence. An anterior hip replacement is not covered by a specific credential system for orthopedic surgeons. 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. If an MRI demonstrates no cartilage damage or subchondral cystification (the development of degenerative cysts), a repairable labral tear and minimal dysplasia, then a hip arthroscopy may be considered. How long will my hip replacement last in your opinion? Welcome to Brandon Orthopedics! 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. Optimal component positioning also is critically important for the best stability and longevity. Click to enable/disable _gat_* - Google Analytics Cookie. http://holycrossleonecenter.com/blog/hip-resurfacing-or-total-hip-replacement-a-candid-discussion/, http://holycrossleonecenter.com/blog/metal-on-metal-hip-replacements/, I wish you the very best recovery. What do you consider to be the most important factors in choosing a surgeon? How does it affect the actual success of the Infection: You are given IV antibiotics before and after 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? Driving hurts too. Back to work/driving in 10 days. 2015 Aug. 3 (13):179. I walk a lot in my job and bend lots (work with children) and sitting causes pain due to impingement. This does expose the patient to more radiation but can help with component positioning and sizing. The most common reason or diagnosis that leads me to replace the hips of young women is hip dysplasia. Iliotibial (IT band) damage, had 2 months of ART release work on this issue. These other conditions need to be defined and hopefully ruled out as the primary source of pain. Uncemented. Total hip replacement is a step-by-step surgery to replace the hip socket and the ball at the top of the thighbone (femur). Excess weight causes a hip joint that has already been stressed to become more painful and disability-causing. 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. I really appreciate this website. 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. I dont know what happens on that tablewas he in a hurry on Friday afternoon. Very slow recovery. This interval must be developed and the muscles must be separated in order to reconstruct the hip. But I am now in chronic low grade pain thats getting worse and dont know what I should do. But I feel that time could be lost and all my symptoms may become irreversible. Over the years, these precautions and the length of time to adhere to these limits have been challenged both by clinicians and patients. I am feeling like this is a business like everything is else. I would encourage you to discuss your concerns with you surgeon. I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. Finally, in July 2013, the first SuperPATH Hip replacement in Australia was performed in Nepean Private Hospital, Sydney. After reading your blog Im thankful he suggested this approach. I also would find out your surgeons recommendation regarding activities and restrictions. Because the muscle fibers are separated, not cut, the nerve path is not disturbed and the muscle is not injured. Hip Resurfacing vs Hip Replacement: Know The Difference Obese or extremely muscular people may not be the best candidates for this surgical procedure. Hi, Most individuals who have had total hip replacement surgery fall into this category and simply resume their lives.. Thank you very much for taking time to reply me. Dr. Parsons has extensive experience in the posterior, anterior and superior (SuperPATH) approach to total hip replacement having performed hundreds of each. I think it perfectly ok to discuss different approaches and ask for an opinion. It is nice to see honest Q&A versus a marketing page. Your out-of-pocket costs for your hipreplacement will be impacted by a number of . Historically in my practice I performed many Bilateral THR and TKR and have backed away from that practice. Finally, hip replacement surgery is expensive and may not be covered by insurance. I spoke in person to probably 4-5 of his success patients and went with hearing from them. 2021 May 20;16(1):324 . Other preoperative guidelines, such as using a prescribed pain medication and keeping the incision clean and dry, should also be followed by patients. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. She never though mentioned an increased risk of damaging femoral cutaneous nerve or possible muscle damage that would turn into improperly heeled muscle as a result. The new prosthetic socket must be medialized (placed further toward the midline) and sometimes through the medial wall of the native socket. My surgeon uses the posterior approach. Is a prerequisite for THR to have a MRI or Pet Scan? This often leads to a less than optimal component position. I wish you well. They thought surgery to repair it would give me about 5 yrs. There is a possibility that blood loss may be reduced as there is less unnecessary exposed bone surface left to bleed. General comments will be answered in as timely a manner as possible, Hip & Knee Surgery It is critical that the patient is aware of the risks, benefits, and alternatives of the procedure. I would also like to know about the customized implant, as I havent yet heard much about it. If your surgeon did a great job, that is something to respect. Thank you, Lisa Blumthal. Do you also do arthroscope surgery? This improved quality of life will be beneficial. Because the anterior hip replacement surgery is a minimally invasive procedure, no cuts are made to the muscles surrounding the hip. The leg lifts really aggravate the front of the hip. The same is true for a surgeon who employs the anterior or anterior technique. Your surgeon will know better than anyone else just how stable your new hip is immediately after your surgery and how securely the surrounding tissues were repaired after the reconstruction. Im sorry to learn that you are so disappointed with your hip replacement. I have congenital hip dysplasia which has gradually caused more pain as Ive gotten older. Minimally Invasive Total Hip Arthroplasty Technique - Medscape Ann Transl Med. more nutritious, too. An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. Everyone I know that has had both posterior and anterior surgery say not to even consider posterior. One thing I do not want is any muscles or tendons cut in the procedure. I wish you only the best, 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. 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. Your symptoms still sound mechanical, positional and episodic. Some other methods are effective, but they are less effective for patients who leave the hospital earlier. Would not make eye contact. It can lead to numbness in the thigh and, in rare cases, skin irritation due to the nerves presence. 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! Again, considering my own practice, I routinely see my patients recover faster and easier after their second hip or knee replacement because they are more confident having had a good first experience. Clearly, he or she has earned your respect and confidence. Seeing that a THR is considered major surgery, my question is, should I have my left hip done sooner than later to address the length difference or wait until I can no longer tolerate the pain? More soft tissue trauma can result do to this increased difficulty in exposure and then gaining more exposure if necessary. Is THR something that can help? 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. The anterior approach, as a marketing tool, has grown in popularity among surgeons. General comments will be answered in as timely a manner as possible. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. 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. A ceramic-on-ceramic bearing is also a very good bearing. Going in for THR in July. Stay was 2.5 days. Raleighs orthopaedic clinic is board certified and has fellowship training in total joint replacement. 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. Procedures That being said, I agree completely with your surgeons advice to have a total hip replacement and not a hip resurfacing. Walking is the best exercise. I know the most important decision you will make is choosing the doctor who will perform your surgery. 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!" The only problem Ive had post hip replacement is some on/off again groin pain. Celle said: Superpath may give you a faster early recovery, but whatever method is used, recovery is still going to take a long time. It does sound as if proceeding with a THR is appropriate, since your attempt to repair the joint arthroscopically did not pan out. Also if the mini posterior approach is so effective when would it not be preferred over the regular posterior approach? Both approaches have been shown to have potential in research. 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. These are all realistic goals. Start your day off right, with a Dayspring Coffee The surgical "approach" in total hip replacement describes the anatomical pathway and technique that the surgeon uses to access the hip joint to perform the surgery. It's cut off and removed through the hole. J Orthop Surg Res. I try not to bring up my mess but its hard when its with one 24/7. This treatment is much more definitive and predictable. Also I have read that there is a sharp learning curve that must take place in order to do the direct anterior approach. Anterior vs. Posterior, Posterior vs Mini-posterior. 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. Cons of Robotic Assisted Surgery As with any type of procedure, Mako is not without its drawbacks. A shorter hospital stay and faster recovery are typical of this because there is less damage to the muscles. The mini posterior approach works wonderfully and predictably when expertly performed. Can You Go Home the Same Day After Hip Replacement? Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. Above the ankle to the thigh.Had to use leg brace to 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. Dr. William Leone. Dear Jo Anna, Can I make an appointment with you. When performing anterior anterior reconstruction, these patients frequently have very short stems that are inserted into the bone. If your surgeon cant answer your questions about hip replacement or provides unsatisfactory answers, you may need to consult another surgeon. 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. Evidence review for hip replacement approach - NCBI Bookshelf The most important decision you will make is choosing your surgeon. 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. Dr. Leone, I am coming in to see you for an appointment for a THR to my left hip. In the case of a worn or damaged ball and socket, artificial parts can be used to restore joint function. I wish you a full and speedy recovery. I wish you the best of luck, My recommendation is to go back to your surgeon and share your concerns and issues to see if a fresh and thorough reevaluation wont help define the problem(s) and solutions. There is no definitive answer to this question as different people will have different opinions and preferences. 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.