I am having the mini posterior done in June and my surgeon gave me the pros & cons of both. Thank you. I think it perfectly ok to discuss different approaches and ask for an opinion. Most activities of daily living have an element of hip flexion (knee up to head), which is a safe position after the anterior total hip. Hi Frances, did you have surgery posterior Superpath? I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. Some in the early period have good track records, others do not. I had the surgery on June 22 and I am about 5 weeks post op. Many also mate this with a ceramic femoral head. But after reading your articles, I am hesitant about that choice now. A couple of things I am hoping you will explain using laymans termology. 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. The most important decision you must make is choosing your surgeon. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. Recovery time for anterior hip replacement is typically two to four months, and recovery time for posterior hip replacement is typically four to eight weeks. 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. I have never operated on another surgeon who asked me to make as small an incision as possible or use the minimally invasive approach. Each surgeon approaches these issues individually. The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior 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. There are a number of different potential surgical approaches available for hip replacement, each with their own potential advantages and potential drawbacks. You are to be commended for taking the time to answer our questions. Following anterior hip replacement surgery, avoid soaking in hot tub, sauna, or swimming pool immediately after surgery. 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. I would research and find the physician and hospital that will give you the best chance of doing well. Hello Dr Leone, A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). Many manufacturers are responding to the surgeons desire for shorter stems and many are now available on the market. A ball and socket are used to connect the new joint to the thigh bone (femoral bone), which is made of metal, plastic, and ceramic. Im 51, 59 and 148 and want to get back to tennis etc, this has been long frustrating process. During the hip replacement procedure, the surgeon makes a small incision near the front of the hip to allow for the removal of damaged anterior bone and cartilage, as well as the implantation of an artificial hip without damaging the surrounding muscles and tendons. This interval must be developed and the muscles must be separated in order to reconstruct the hip. I would rather see my patients go home. In my last blog post, I discussed minimally invasive surgery with regard to hip replacement. Why is that? We have an appointment today to discuss the plan of action. I had an anterior approach hip replacement. There are a few disadvantages to hip replacement surgery. 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. Blood clots or bleeding. Patients can also have as little as a 3-inch incision. Felt very uninformed and left 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! Everyone I know that has had both posterior and anterior surgery say not to even consider posterior. Intervals between muscles are separated or muscles are separated in line with their fibers without injuring the muscles innervation. I am 56 now and find that physical therapy and chiropractic care dont seem to be helping anymore. What is most important is choosing your surgeon. I ask my patients to restrict certain positions that exceed the mechanical limits of the artificial hip for the first six weeks. Evidence review for hip replacement approach - NCBI Bookshelf I had an MRI by a different hip doctor (a preservationist) who diagnosed me with a birth defect (hip dysplasia). I never seem to know when I am going to get hit with pain. It was also observed to be associated with longer surgery times. It is critical that the patient is aware of the risks, benefits, and alternatives of the procedure. By far the most important variable is the doctor who is doing your surgery and managing your post-op care. 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. Blog Most patients are able to walk the day of surgery. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. My surgeon does the SuperPath method. I will need the other hip done within the next 6 months, and despite all the talk of the anterior approach- I can use myself as the best judge to the best method. All: If you refuse cookies we will remove all set cookies in our domain. I also think infection must be investigated and ruled out. Also, how about hip restructuring instead of Total Hip Replacement. Or are x-rays definitive for determining the exact reason for THR? Does this mean my body may reject the metal of the post or cup? Its been 9 months(Ive had it 2xs bf and got rid of it and have tried everything and no results this time). An anterior approach hip replacement is one of the most minimally invasive surgical options for replacing a hip. I would emphasize choosing your surgeon and not the approach. Need to choose, then select doctor based on that decision. The other things that can affect the op is your fitness beforehand, your attitude and your age, although you may have difficulty getting younger!! The parts may be attached to the bones in one of two ways. I wish you the best of luck. 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. Pain Management It typically requires a 4 to 5 day hospital stay, 3 to 6 month recovery period . Getting those studies will not change the reality that you will need THRs. The rest is marketing. Infection. Many others feel the same. Above the ankle to the thigh.Had to use leg brace to Unfortunately, injury to the lateral femoral cutaneous nerve is a common complication after the anterior approach for hip replacement. Advantages of an anterior approach to hip replacement A major muscle is not cut during the anterior procedure. disadvantages of superpath hip replacement. In the front of the hip, fewer muscles are present, so the surgeon works between them instead of cutting through them and then detaching them (and then repairing them after the surgery). 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. I am scheduled to have total hip replacement surgery in 2 weeks. But this will always prompt you to accept/refuse cookies when revisiting our site. Obese or extremely muscular people may not be the best candidates for this surgical procedure. Because I have scfe also in my left hip, I will have to have it fixed too. Hip replacement - Mayo Clinic Getting in and out of cars, and turning over in bed. By adhering to the surgeons instructions as well as their pre- and post-operative instructions, you can reduce your chances of complications. Advantages and Disadvantages of Anterior Hip Replacement Does anyone ever attempt to do both at the same time if THR is determined? It is possible that you will be required to avoid certain high-impact activities to protect your new hip. (a) Components of a total hip replacement; (b) The - ResearchGate Imagine your femoral head lacking full acetabular coverage, resulting in an overloading of the superior aspect of your socket, hence the cartilage and labrum becoming damaged and ultimately breaking down. I have seen a number of patients who were reconstructed with the anterior approach who developed painful anterior scarring after the procedure. The most common total hip replacement method is the anterior approach, which allows the surgeon to see better, more precisely place implants, and perform less invasive total hip replacement surgeries. 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. There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. Can You Use An Inversion Table With A Hip Replacement Total hip replacement is a step-by-step surgery to replace the hip socket and the ball at the top of the thighbone (femur). Dr. William Leone, Hello Dr. When it comes to revision surgery, we rely heavily on the posterior approach. Many, many interactions and decisions go into the final result as well as someones perception of his or her result and experience. You can also change some of your preferences. I would like to share my experience with both procedures. If a patient has abnormal anatomy (such as dysplasia, posttraumatic arthritis, or morbid obesity), or if their body mass index is higher than 35, it may be impossible for them to be considered for direct anterior surgery. Hip dysplasia is a very common underlying cause of hip osteoarthritis. 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. I definitely would not recommend a hip scope and THR during one anesthetic setting. I understand that most surgeons now do a spinal rather than general anesthesia. If I do a single hip or knee replacement, that patient is out of bed standing and, in most cases, walking the afternoon of surgery. In general, if someone is dedicated to the job, the return is very quick. I am planning to have a THR this summer. There are risks and recovery times associated with surgery. Even if the hip doesnt dislocate, prosthetic or soft tissue impingement is not beneficial. The surgeon I went to said he does THR using a lateral approach. Welcome to Brandon Orthopedics! I also think its reasonable to look forward to returning to all of the listed activities that you enjoy. 1. Pain is almost gone and I am beginning to get back to my life. Its also reasonable to ask to speak to other patients who have undergone THR using this technique to learn about their experiences and results. What are your thoughts on the use of robotics? No one tells me the same thing? Dr. William Leone. Historically short press fit stems have not done well. I have read your articles about procedures (anterior vs posterior). I would focus on the individual doctor, not the approach that the individual choses to use, to deliver the best result. These cookies are strictly necessary to provide you with services available through our website and to use some of its features. Please do not take this as an attack, but your article seems biased on your experience (great results with min. My gait is off partially due to my hip but also I believe because of my body structure. This allows you to resume normal daily activities quickly while also returning to normal range of motion and function. Although anterior approaches can be useful for some, they are not for everyone. This is not true for bilateral cases. The vast majority of my patients return to work one to three weeks post-operatively. This can be dangerous because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. I think speaking to a patient with whom you can relate and who has been treated by the physician youre considering also is invaluable. If was 3 weeks after discharge Mine certainly have. Also had Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. 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. Surgical Approach Types | Hip Replacement | Elvis Grandic, MD Does my prothesis not last as long since I am now doing a 3rd surgery? I am 5 weeks out and have been doing beautifully! 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 . Thanks for giving us patients the kind of information we need to be more educated as to what questions to ask. I was released to go back to work after only 10 days. I would anticipate that you would be able to return fully to your activity once the tissues around your total hip heel. I very rarely transfuse any patients now. Choose your surgeon. 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. Thank you. The mini posterior approach essentially is the same as the traditional posterior, however a smaller incision is made and less soft tissue is exposed. I love that you take time off to reply to these messages it is commendable. Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. The same is true for a surgeon who employs the anterior or anterior technique. The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. Hard-on-hard bearings, such as ceramic-on-ceramic as well as metalon-metal articulations, also resulted in larger femoral heads being implanted. I spoke in person to probably 4-5 of his success patients and went with hearing from them. Anterior hip replacement is a type of hip replacement surgery. Stay was 2.5 days. I then would strongly suggest you trust that person to decide what approach and what prosthesis predictably will deliver the best results. Ill know a lot more after we meet and I review your X-rays. 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. Im so pleased to learn that you had a good experience. Risks of Hip Replacement Surgery The major risks include the following: Blood clot: We do reduce risk of this by using blood thinners (Enoxaparin, Aspirin or Coumadin), TED hose (compressive stockings) and compression boots on your feet to increase circulation. 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. Having a THR is a major undertaking and it is reasonable to expect the hip construct to function optimally for twenty and more years. All rights reserved. I am a 70 yr old female with a 4grade thickness loss at acetabulum and head of femur. thank you for your time. It's cut off and removed through the hole. It is nice to see honest Q&A versus a marketing page. . The doc I saw yesterday said 4 weeks. Patients are told how to use their hip after hip replacement surgeries, which is very different than the usual practice. Adults of any age can be considered for a hip replacement, although most are done on people between the ages of 60 and 80. Thank you for sharing with others the nerve supplements that youre finding affective. It can lead to numbness in the thigh and, in rare cases, skin irritation due to the nerves presence. Some people also tend to form scar tissue and contracture more readily than others. The surgeon accesses the hip joint from the front of the hip, rather than from the back or side. Can you suggest any pain medication that would not interfere with anti rejection drugs? After reading your article I am concerned about the issues you discussed. My hope is that some of these symptoms will improve with time. In comparison to traditional methods, anterior approaches to the hip joint are more effective. Most of the restrictions are removed at that time, although I still advise common sense, particularly for the first three or four months. I was discharged within 24 hours. 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. Its from a malformation. It does sound as if proceeding with a THR is appropriate, since your attempt to repair the joint arthroscopically did not pan out. I have dealt with my hip pain and limping for over a year, can no longer perform my daily activities, and cannot sleep well anymore.