I have congenital hip dysplasia which has gradually caused more pain as Ive gotten older. I would rather this not happen with my right leg when I have the THR in Jan 2017. That's all I know. The posterior approach is used frequently again, in large part due to the fact that it is an extensile approach. I am scheduled for total hip replacement in about 3 weeks, and none of these procedures/options were discussed with me.the surgeon just said that it was a risky surgery and he could not guarantee anything! I have seen 4 surgeons. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. I wish you a full and satisfactory recovery. Finally, hip replacement surgery is expensive and may not be covered by insurance. 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. I have many patients who are accomplished and passionate ballroom dancers. Original Medicare (Part A and Part B) will typically cover hip replacement surgery if it's medically necessary. It's what compelled me to seek out different methods and post here.. You will find the surgeons will all give the pros but never the cons what ever the method. Does it really not matter which approach I have, posterior or anterior? Individual results and activity levels after surgery vary and depend on many factors including age, weight and prior activity level. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. I still have some questions I hope you can answer as this is so distressful for me. 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). Due to security reasons we are not able to show or modify cookies from other domains. I have a yr or more off work so I have the time to heal properly but scared to sit or move an Inch as I dont want to dislocate my hip again I dislocated my left hip in a resturant while eating lunch with my 10 yr old we both suffer from ptsd now and stayed in the emergency room for 30 hrs before they rushed me to the city hospital. Always speak to your doctor before acting and in cases of emergency seek I would like your opinion on the stem cell injections as I am really afraid of the second surgery on the same side of my body. Can you compare/contrast to the other approaches; posterior, mini posterior, anterior? Does this mean my body may reject the metal of the post or cup? One thing I do not want is any muscles or tendons cut in the procedure. There are numerous complications associated with hip replacement surgery, but blood clots in the legs and hips are two of them. Personally, I would not gamble with my health. 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. In May of 2015, I had a Labial tear repaired. This effectively moves the hip joint center, toward the bladder or midline, and improves hip mechanics. Can you suggest any pain medication that would not interfere with anti rejection drugs? I ask my patients to restrict certain positions that exceed the mechanical limits of the artificial hip for the first six weeks. The activity that I wish to have the most success with after the surgery is ballroom dancing. I am 5 weeks out and have been doing beautifully! The development of a complete and secure surrounding scar tissue wall or pseudo capsule is critical for stability. The doctor is planning a traditional posterior. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. Your frustration is completely understandable. 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. Some people also tend to form scar tissue and contracture more readily than others. 2021 May 20;16(1):324 . Your back does need to be evaluated as well. Thank you. It is critical that the patient and the doctor consider whether the patient is a good candidate for surgery, the cost and recovery time, and the surgeons expertise. I would suggest seeking out doctors who specialize in hip replacement surgery rather than general orthopedics. As a result, patients can return to their normal activities much sooner than if they had had traditional hip replacement surgery. Do I have a risk of fractures during a posterior right hip revision due to my prior complications already? My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. What is most important is that you find a surgeon who understands the particular complexities with your problem and whom you trust. Studying a hospital and physicians track record before you commit is important. By far the most important variable is the doctor who is doing your surgery and managing your post-op care. Advantages of an anterior approach to hip replacement A major muscle is not cut during the anterior procedure. I think it perfectly ok to discuss different approaches and ask for an opinion. It's cut off and removed through the hole. I have/had arthritis in my hips. 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. Check to enable permanent hiding of message bar and refuse all cookies if you do not opt in. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. Because the dissection is over the front of the hip, a number of patients will experience residual pain and tightness anteriorly (in the front of the hip) at least early on. Does the mini posterior hip replacement conserve more femur and allow for future surgeries if needed ? I am sure you should not listen to what I did!! My question is, what will my restrictions be? Ill know a lot more after we meet and I review your X-rays. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. There are many effective approaches and techniques that allow implantation of a total hip. 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. The last page is asking the participant to self score their health that day out of 100. Really Great. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. I exhausted all other non-surgical options, such as physical therapy and meds but to no avail, so now plan to have a THR in March. The femoral nerve functions to extend the knee and also is responsible for sensations over the anterior and medial aspects of the thigh, medial shin, and arch of the foot. The risk of revision surgery after a posterior hip replacement is the most serious concern. My main concern is that I have a tilted sacrum and a very sway back. I then would strongly suggest you trust that person to decide what approach and what prosthesis predictably will deliver the best results. With much respect I look forward to your reply. Hip anatomy Remember, what youre hoping to do is have a hip construct that will last 20 years or more. I have not seen this before because in the past, the complication from hip surgery were sciatic nerve injury from posterior approach. Intervals between muscles are separated or muscles are separated in line with their fibers without injuring the muscles innervation. When compared to the anterior approach to hip replacement, which is typically more painful, there are several advantages to recovering from an anterior approach, including the fact that you will not be required to follow any specific anterior hip replacement precautions, such as bending or crossing your leg. I really appreciate this website. I do not do hip arthroscopy. The surgery time is much less with a single joint and therefore the sterile surgical instruments are opened and exposed to the environment for a shorter time. Felt very uninformed and left In my experience, there is a faster and more-consistent recovery with the mini-posterior. 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? Im a very healthy long distance bicycle rider. This is described as a posterior approach because the actual hip . Only Dr. Leone will be using the most recent hip technique known as the SPAIRE technique as of 2020. The first is that it is a major surgery, so there is a risk of complications such as infection. The anterior approach, as opposed to the lateral or posterior approach, uses a small incision in the front of the hip. I am so sorry to learn that you are struggling. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? [QxMD MEDLINE Link]. Getting those studies will not change the reality that you will need THRs. The mini posterior approach works wonderfully and predictably when expertly performed. Considering I had no idea about differences between the two approaches, I said OK and surgery did go well and I was back on my feet in no time. I have had problems with my hip for the last several yrs. If not, what will my restrictions be? Most patients after a bilateral procedure would not go home but rather a rehab unit. 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). Your article lacks the pros of the AMIS and the cons of min invasive posterior. I would avoid the metal-on-metal articulation. 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. That I knew this recovery may take 1-2 Conserves the two main muscles that make up the front of the hip and upper thigh aspirated via the direct anterior approach. . Behavior. Tossed the cane at three weeks and went back to work. There arent any activities that you can do with a resurfaced hip that you cant do with a total hip. It is generally agreed that the temporary numbness is more than balanced out by the substantially improved recovery, reduced pain, absence of a limp, faster return to function, and virtual elimination of the risk of hip dislocation. That's all I know. Dr. Parsons has extensive experience in the posterior, anterior and superior (SuperPATH) approach to total hip replacement having performed hundreds of each. With SuperPath, there is no surgical dislocation of the hip. 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. With mild dysplasia, positioning and implanting the new cup usually is not more difficult than with other conditions. Optimal component positioning also is critically important for the best stability and longevity. I should think that all your expectations are appropriate for the activities you look forward to, especially considering youve already done so well after your knee replacement. What are your thoughts with regard to Stem cell therapy in lieu of THR? Do you agree? Share your concerns with your surgeon. I was told the joint lubricant had migrated into the hip bone creating the cyst, There is effusion in the joint and stress areas. The amount of PT you need after surgery will be determined by you and your surgeon. 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. In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. I prefer reconstructing the most symptomatic side first. I had the mini-posterior at MGH hospital. Finally, many people who are struggling with hip disease experience lower back pain or even sciatic discomfort. I would stay away from narcotics. 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. I am an obese female and will be 62 in February. If I think you may be a candidate, I will refer you to a doctor in our area that does. 4 mts later am using Patients are told how to use their hip after hip replacement surgeries, which is very different than the usual practice. I believe this is an important discussion you should have with your surgeon preoperatively. I have been told that I can fly 48 hours after surgery?? Bleeding at the operative site can occur as a result of an anesthesia reaction, such as an allergic reaction. I just want to thank you for the information on this site. An anterior hip replacement is not covered by a specific credential system for orthopedic surgeons. The second most-common injury is to the femoral nerve. After reading your blog Im thankful he suggested this approach. So my question is in relation to my body structure. What surgical approach is typical for a complex total hip replacement? The leg lifts really aggravate the front of the hip. Ive done PT and plan to continue working on strengthening my core and flexibility of those large muscles. If this occurs, the patient usually requires a total hip replacement. Click to enable/disable _ga - Google Analytics Cookie. Even a task as simple as putting on socks and shoes can result in debilitating discomfort when a severely damaged or arthritic hip is involved. Also had Common conditions that often lead people to have either posterior or anterior hip replacement surgery include the following: Osteoarthritis Rheumatoid Arthritis Osteonecrosis, also known as Avascular Necrosis Injury Fracture Bone Tumors I think the recovery time is the same though. I assume PTHR is referring to partial hip replacement. We can help you make the best decision for your knee replacement, and our friendly staff is available to answer any questions you may have. I weigh 185 and am 54 and realize its ideal to lose weight prior to surgery (working on it as always). Very few metal-on-metal bearings are being placed today due to the serious potential of metallosis. It's cut off and removed through the hole. I understand they have good results in Thailand or India for half that. What is the best stem and ball/socket combo to use for someone that ones to play tennis? Length of hospital stay with SuperPath hip replacement approach. Can I make an appointment with you. There is also a small risk of infection at the surgical site. Is THR something that can help? 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. My doctor does not do mini posterior, therefor I have a 6 incision. Many believe that this results in less risk of infection. Uncemented. Very strange Its been my experience that patients who go into surgery well informed have a better experience and seem to rehabilitate more quickly. The same is true for a surgeon who employs the anterior or anterior technique. Disadvantages of the anterior approach include: Although I am trained in both approaches and have trained surgeons in both approaches, I have stopped using the anterior approach because I saw my patients get well faster, bleed less, and have a more predictable result when I performed the surgery using a mini-posterior approach. With the ease of movements during pregnancy, you will be able to move around more freely. I ride horses, water ski and kayak. We are always refining and trying to make it better. 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. That means you have an excellent track record. #1. Thigh feels so Heavy and I massage that area a lot. Rather, they say Bill, please just do what you have to do and do a great job. One advantage the ceramic-on-polyethylene carries is the lack of . Problems such as osteoarthritis, rheumatoid arthritis and avascular necrosis can destroy the protective cartilage around the hip joint, disrupting the smooth contact between the femoral head (ball) and hip socket. Every patient needs to have as limited an approach and dissection as possible that does not compromise the final implant position or create excessive trauma to the soft tissues. Also, after an accident, I had 12 screw and an L shaped plate in my heel. Your article is the first Ive read in which no muscle or tendons are cut in any approach other than the direct anterior approach. Hard-on-hard bearings, such as ceramic-on-ceramic as well as metalon-metal articulations, also resulted in larger femoral heads being implanted. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. I believe a THR will benefit you tremendously. My two questions are: 1. 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. Im a 50 year old female whose been dealing with hip, leg and back pain for many years, recently diagnosed with OA, and finding that I need a right THR. As a result of the interventions, the surgeon has a better view of the hip joint. The anterior approach has a lower incidence of sciatic nerve injury and a higher incidence of femoral nerve injury. You can resume your active lifestyle as soon as possible thanks to a new prosthetic hip. I love that you take time off to reply to these messages it is commendable. But this blog was a nice nudge toward the posterior. I understand that most surgeons now do a spinal rather than general anesthesia. This site uses cookies. Is AL better than P for this? Lastly, if one has had P or AL is there anything that can be done to offset the need for restricitons? I was told to wait 6 weeks before I resumed my exercise regiment. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. The impingement can be between the metal neck of the stem and edge of the cup or between soft tissues. I needed no physical therapy at all. Having diabetes and two organ transplants does significantly increase your risk for post-op infection as well as other complications. It is also important to avoid any sudden movements or twisting motions. Kenneth, You saw me in your office yesterday (I am 48 years old) as I had complications following a THR of right hip anterior approach with revision 4 days later for a slipped acetabular and then last week I had a dislocated hip. I think tennis, dancing and horseback riding are fine. Choose your surgeon and not the approach or prosthesis. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. Dear Dr. Leone, Click on the different category headings to find out more. Try our Symptom Checker Got any other symptoms? I live in Staten Island and need rt hip replacement. I had the surgery on June 22 and I am about 5 weeks post op. 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. Many studies suggest that any limp or clinical weakness resolves after approximately three months. not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in As you can see, there are no restrictions. The mini-posterior is considered a more straightforward approach then the anterior, resulting in lesser complication rates. The anterior approach is not as muscle sparing as some would argue. I also recommend that you look at the track record and reputation of the hospital where the surgery will be performed, especially considering the underlying cardiac and vascular issues. This complete wall of tissue that surrounds the new hip imparts stability. No feeling in my leg and no movement Recognize that the underlying etiology is not being corrected by this procedure, so relief of symptoms probably will be temporary and possibly partial. There is a chance of nerve injury with any type of hip replacement. With a significant learning curve, it is likely that you will have to replace about 100 hips before you are truly comfortable with the approach. A ceramic-on-ceramic bearing is also a very good bearing. 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. Ultimately, you and your surgeon should discuss all procedures and technologies available and then trust that your surgeon will choose the best course of treatment and surgical procedure for you. Here are a few of the advantages of anterior hip replacement. If theyre really happy and got well quickly, you probably will too. Thank you for this great informative discussion. It exploits the same soft intervals but it typically accomplishes prosthetic implantation and soft tissue balancing through a smaller incision and, more importantly, with less underlying soft tissue dissection. Surgical approach is important but its just one of many important variables. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. I read about this type of mini hip replacement being done in the UK and just wondering if mini hip replacement means the same thing in the US . The posterior approach for hip replacement surgery is by far the most common surgical technique used in the United States and throughout the world. Can You Use An Inversion Table With A Hip Replacement If these values are elevated, further investigation with hip aspiration should be considered.