I just want to thank you for the information on this site. 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. Need to choose, then select doctor based on that decision. Dont let PR marketing confuse the big picture. I was told the joint lubricant had migrated into the hip bone creating the cyst, There is effusion in the joint and stress areas. If I think you may be a candidate, I will refer you to a doctor in our area that does. Most of my patients now go home the day after their surgery or the next. My worry is that I will end up with one leg shorter than the other. Also, only a small percent of C-on-C bearings are being implanted at this time. That's all I know. Blog bible teaching churches near me. Would you recommend treating plantar 1st? Thank you. I still have a very big limp and still undergoing physical therapy. Thank you for sharing. Usually a hip problem is addressed before a knee or foot problem because by solving the hip problem first, the knee or foot often improves if the pain is referred from the hip (more common with knee pain) or if by addressing the hip, the body mechanics and the fluidity of gait improve. If your surgeon has recommended surgery, I assume youre no longer getting adequate relief of pain or able to remain active with conservative measures. The vast majority of my patients return to work one to three weeks post-operatively. It is a mix of anterior & posterior. 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. I would not anticipate them improving with time, but rather worsening, and I cant imagine you being able to resume the activities you described without having surgery to treat this. The art of surgery should mimic a well rehearsed ballet or symphony. 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. Irrespective of the approach that is used to implant the prosthesis, the tissues that surround the new prosthetic hip must heal and mature if the hip is to achieve stability. Dr. Tom Miller gives you the five best options for hip replacement surgery. The information I have gathered seems to indicate the anterior approach is more inherently stable, making precautions unnecessary. Choosing a surgeon should be based on published data (if available), as well as his or her reputation in the community, according to Dr. Delcore. Uncemented. It can lead to numbness in the thigh and, in rare cases, skin irritation due to the nerves presence. I would rather this not happen with my right leg when I have the THR in Jan 2017. 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. I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. I then stage the second surgery as early as 2 or 3 weeks post-operatively. Will I still be able to do all of these things? Often in this group of patients, their X-rays show only minimal cartilage space compromise (it may appear thinned and irregular) and I observe at time of surgery that the labrum appears hypertrophied (to compensate for lack of head coverage) and often torn. The new prosthetic socket must be medialized (placed further toward the midline) and sometimes through the medial wall of the native socket. THOUGHTS? 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. Also I have read that there is a sharp learning curve that must take place in order to do the direct anterior approach. Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. Ann Transl Med. It helps the surgeon implant the acetabular component in a very precise position. I began using the superior approach for total hip replacement in February of 2014. . J. Dear Dr. Leone, Should I go for this or should I opt for the mini posterior. A hip replacement is an excellent option for people who suffer from significant pain and disability as a result of arthritis in the hip joint. Anterior hip replacement is a type of hip replacement surgery. Not sure exactly what that means. They may have a certain cut-off criteria (for example, a BMI of less than 35). Other preoperative guidelines, such as using a prescribed pain medication and keeping the incision clean and dry, should also be followed by patients. It is critical that the patient is aware of the risks, benefits, and alternatives of the procedure. If you refuse cookies we will remove all set cookies in our domain. I have read your articles about procedures (anterior vs posterior). The vascular supply of your leg must be assessed preoperatively as part of you work-up, but most do very well. The incidence of dislocations has further decreased over the past decade with our ability to implant larger size femoral heads. We now have less-invasive techniques, better surgical methods of closing soft the tissue and more experience. In comparison to traditional methods, anterior approaches to the hip joint are more effective. With much respect I look forward to your reply. This most often leaves the patient with an area of decreased or uncomfortable sensation or numbness over the anterolateral thigh (top, outside area of the thigh), not the entire thigh. 2. Finally, in July 2013, the first SuperPATH Hip replacement in Australia was performed in Nepean Private Hospital, Sydney. Depending on the stability and range of motion observed at time of surgery, some doctors dont advise their patients to avoid any positions. The chances of developing a revision surgery after a posterior hip replacement are low, but you should keep all follow-up appointments with your surgeon and inquire when you can resume activities that go beyond 90 degrees or bend down to pick up something small after your procedure. 4. Six months ago I had a right posterior THR due to severe scfe; now my right leg is 5/8 longer than my left leg. I have a tilted sacrum, sway back and a very large posterior. Because of this, when you're ready to get up and walk about again, engaging your muscles and hip flexors might be extremely tough. First, I am a little bit scared. I am just under 5 ft and weigh 185. Im getting close to needing my left hip done. Does either procedure in this discussion present restrictions or advantages for this sort of movement? Until now. My main concern is that I have a tilted sacrum and a very sway back. I don't think there's a one size fits all when it comes to hip surgery. Also, since I am only 51, I am concerned about component longevity. Total hip replacement is one of the most successful operations ever developed and is a remarkably predictable way to relieve pain from arthritic conditions. The amount of PT you need after surgery will be determined by you and your surgeon. And, I Do. The mini-posterior is considered a more straightforward approach then the anterior, resulting in lesser complication rates. Dr. William Leone. The most important decision you will make is choosing your surgeon. Ultimately, you and your husband need to choose the surgeon who you both feel will provide the possible best care, based on reputation and your personal comfort level. I am going to get evals from 3 docs. I would research and find the physician and hospital that will give you the best chance of doing well. Had arthroscopy in Jan 15, cleaned up tear and arthritis. I would not recommend pushing your surgeon to use one specific approach or another. The most important decision you must make is choosing your surgeon. Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? Are my findings that posterior approach in my situation would have been more appropriate? Following surgery, the surgeon will devise a routine for the patient to engage in that is both comfortable and safe. What reasons would there be to use the regular over the mini? Ive done PT and plan to continue working on strengthening my core and flexibility of those large muscles. Because my husband has circulation problems in his leg and vein removed for open heart surgery last yearhis surgeon recommended the Mini posterior surgery. But I am now in chronic low grade pain thats getting worse and dont know what I should do. The nerve which supplies sensation to the front and side of the thigh is vulnerable. July 2013 my left hip was scoped for a labral repair. Because the femur is more difficult to expose during the anterior approach vs. the posterior approach, many surgeons will select a shorter femoral component to facilitate reconstruction and lessen chance of fracture. If so, is it possible to have both hips done at the same time? This site uses cookies. I never seem to know when I am going to get hit with pain. As a result of anterior hip surgery, there is little need for any special care. In the case of a worn or damaged ball and socket, artificial parts can be used to restore joint function. In hopes that THA would let me live my normal life without arthritis, instead I can barely walk more than 100 yards without having to stop, my gait is crooked causing lower back problems and my personal life is less than perfect. No specifics were given to me from the orthopedist . I think it perfectly ok to discuss different approaches and ask for an opinion. Also there are concerns about disruption of blood supply to femoral head with this operation. Typically, most are eager to go home the very next day; many have already progressed to a cane, which they will not use very long. I dont think one surgical approach is better or worse than the other for you to accomplish this. There has been an increase in the range of motion. Even if the hip doesnt dislocate, prosthetic or soft tissue impingement is not beneficial. An anterior hip replacement is not covered by a specific credential system for orthopedic surgeons. Doctors use metal, ceramic, or plastic replacement parts. I read hip dislocation is 28% higher after a revision, is it more then 28% after 2 revisions??? In general, if someone is dedicated to the job, the return is very quick. We are always refining and trying to make it better. I recently had a spontaneous hip fx and was diagnosed with hip displasia. Inpatient footage of the patient compilation has been edited out to accommodate hospital rules. 4 mts later am using 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. What determines the differences? Thank you for sharing. Click to enable/disable _gid - Google Analytics Cookie. I already have an artificial knee that is doing great. What do you consider to be the most important factors in choosing a surgeon? 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. I deal with OA lower back mess so know I see most likely how all this has played into the surgery. Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. Dr. William Leone. Thanks. Many studies suggest that any limp or clinical weakness resolves after approximately three months. 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. By adhering to the surgeons instructions as well as their pre- and post-operative instructions, you can reduce your chances of complications. What are the risks involved? They thought it would give me about 5 yrs. Most patients are able to walk the day of surgery. There are many different quality implants (just like surgeons and hospitals). Because the mini-posterior is more straightforward, many surgeons think it provides an increased margin of safety for the patient, because the incision can easily be extended if exposure is poor, or if a fracture occurs. My husband, who is only 35, has to consider a THA in the near future and Im very torn over which approach as the surgeon we really like dos a posterior but I am concerned about dislocation rates in posterior vs anterior. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. Having diabetes and two organ transplants does significantly increase your risk for post-op infection as well as other complications. Sometimes, it simply isnt possible to accomplish. Hi, The incision made for the operation can be as small as three inches. Everyone is. My advice is to have a frank discussion with your surgeon and share these concerns. But this will always prompt you to accept/refuse cookies when revisiting our site. In the United States, a traditional posterior approach is the most commonly used. A THR is in my future. Celle said: Superpath may give you a faster early recovery, but whatever method is used, recovery is still going to take a long time. I understand that most surgeons now do a spinal rather than general anesthesia. I am an obese female and will be 62 in February. Blood-thinning medications can reduce this risk. If you have these arthritis symptoms, you should consider a hip replacement: severe hip pain that is not relieved by medication and that interferes with your work, sleep or everyday activity hip stiffness that restricts motion and makes it difficult to walk To learn more, read Here's What to Know if You Think You Need a Hip Replacement. Back to work/driving in 10 days. I am now bracing myself for THR surgery within the next year and am wondering if there is any big advantage in trying to have this done by a surgeon who offers the customised implant, as above. Choose your surgeon. appropriate medical assistance immediately. There are many effective approaches and techniques that allow implantation of a total hip. 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. Intervals between muscles are separated or muscles are separated in line with their fibers without injuring the muscles innervation. Thank you. When it comes to revision surgery, we rely heavily on the posterior approach. I thought the newer procedure on the special table was the best way to go. 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. You can do anything you want after a hip replacement. 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. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. Pain and disability are reduced. My question is: should I just tolerate the pain and limp, or take a chance with the hip replacement. Following anterior hip replacement surgery, avoid soaking in hot tub, sauna, or swimming pool immediately after surgery. A hip replacement with an anterior component does not require major muscle cuts and thus patients are less likely to experience pain and require less medication. Brian Tinsley. Specific protocols, therapy and what positions you will be asked to avoid after surgery and for how long will be directed by your surgeon. No feeling in my leg and no movement 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. Should I be though? This is because the nerve is located in front of the hip. A metal or plastic implant is used to replace a damaged or diseased hipbone. In anterior and posterior surgeries, the outcome is essentially the same a new hip. If so, how long until I can get back to normal living? Its also reasonable to ask to speak to other patients who have undergone THR using this technique to learn about their experiences and results. 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. Return to the work place is an individual decision. But after reading your articles, I am hesitant about that choice now. We are always refining and trying to make it better. That being said, if the foot is now a much bigger problem than the hip, you may have to deal with that first. Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. SuperPath hip replacement is a newer method and has been used since 2019 at Leicester's Hospitals. It also is more difficult for patients with some patterns of arthritis such as protrusio, which causes the worn out ball to migrate inward rather than upward into the socket. No, I would not tolerate the pain and immobility, if there is a reasonable way to relieve it. I was out of bed walking around the evening of the surgery . 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. Dr. William Leone. Click to enable/disable Google Analytics tracking. This complete wall of tissue that surrounds the new hip imparts stability. Being discharged to a rehab unit is now the exception. The most common reason or diagnosis that leads me to replace the hips of young women is hip dysplasia. I was released to go back to work after only 10 days. Le has extensive experience in primary joint replacements, complex revision surgery, periprosthetic fractures, and infection management. SuperPath approach uses about a 3-inch incision at the side of . Ten years ago I had total hip replacement on the left at hss. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. Thank you for this! I am 56 now and find that physical therapy and chiropractic care dont seem to be helping anymore. I wish you a full and satisfactory recovery. Many, many interactions and decisions go into the final result as well as someones perception of his or her result and experience. Im not sure why you developed a problem with your IT band. My acyive 60 year old husband is scheduled to have Mini posterior total hip replacement in 6 weeks. We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. 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. I believe a THR will benefit you tremendously. It is nice to see honest Q&A versus a marketing page. William Leone. That I knew this recovery may take 1-2 It is important to consider the SuperpathTM technique if you are considering a hip replacement. This surgical procedure is performed with a patient lying on their side, and a surgical incision made along the outside of the hip. The doctor is planning a traditional posterior. In my 25 years of practice, the variable that seems to have changed the most is how quickly people recover from this surgery when done well. Length of hospital stay with SuperPath hip replacement approach. With that said, I would have probably just done the posterior with you if we lived in the US based exclusively on the time you take to respond! Regardless, the overall incidence of dislocation for every approach is smaller due to use of larger femoral heads and enhanced closure techniques. This suggests that something changed after five months. Registered in England and Wales. It is critical to make the right decision regarding anterior hip replacement surgery in each case. It is so important to stay focused on the outcome of your hip replacement surgery: excellent results both short- and long-term with minimal risk of injury or complication, and not lose sight of the real goal, which is to create a perfectly positioned reconstructed hip that is stable, balanced and has the best possible chance of lasting more than twenty years. Dear DR Leone, Patients mobilize the day of surgery and typically go home the next day. The rest is marketing. Rather, they say Bill, please just do what you have to do and do a great job. If was 3 weeks after discharge Also, I am diabetic and have had two organ transplants and am extremely worried about infections, etc. Risks associated with hip replacement surgery can include: Blood clots. Do you also do arthroscope surgery? I saw a surgeon who does the posterior approach only and will see another on 4/14/15 who does both approaches. We provide the best cash prices and customer care in the industry. The activity that I wish to have the most success with after the surgery is ballroom dancing. 5. and Privacy Policy and steps will be taken to remove posts identified Did you have the surgery via Superpath method? I ride horses, water ski and kayak. 1.2. 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. Soft tissue contractures often are associated with long-standing arthritis. If they did develop five months post-op, then you have to consider that it could be a manifestation of back pathology compromising a nerve root. It's cut off and removed through the hole. 2012 Oct 17;94(20):1897-905. doi: 10.2106/JBJS.K . I needed no physical therapy at all. Its interesting that when we critically analyze all the variables that ultimately make up the experience that one person has compared with another, or that one person experiences on one side versus the other, we come to recognize its not so straightforward. Are these expectations realistic? 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. I live in the UK so again Im afraid I wont be able to consult you personally! As a result of the interventions, the surgeon has a better view of the hip joint. I am suffering from a severe range of motion where I cant put my left sock on or tie my left shoe, I can barely get in and out of low cars and sitting up at a table hurts too! Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer. Thru X-rays Ive been told both hips are bone on bone! I wish you a full and speedy recovery. The pain I get is in the groin and a sharp pain in the buttocks, that feels like muscle pain. Driving hurts too. According to Dr. Rosen, the most important thing to remember is what you leave behind rather than how you get there. 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 . When a patient feels better, they can return to work almost immediately, though it usually takes two weeks or longer. Pain is almost gone and I am beginning to get back to my life. 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. Depending on the degree of injury, you may need a knee brace to lock you knee in extension when walking until the quad function returns. General comments will be answered in as timely a manner as possible, Hip & Knee Surgery What is most important is choosing your surgeon. There is no way that you can recover fast from having bones cut and shaped and large metal objects inserted into them. Im an avid skier and just found out I did not have full Anterior but rather AL. Does anyone ever attempt to do both at the same time if THR is determined? Just getting your thoughts I will discuss it more with my surgeon at the pre-op meeting. Testimonials I wish you the best of luck, Get Directions, Phone: 954-489-4575 In the hands of a master, all can produce wonderful and predictable results. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. This technique is also referred to as the . There are numerous complications associated with hip replacement surgery, but blood clots in the legs and hips are two of them. Will I still be able to do the things I like to do? I just saw a patient with a femoral neuropraxia after a anterior approach THR. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. A number of patients who have undergone this procedure are able to walk unassisted the day after surgery . Hip dysplasia is a very common underlying cause of hip osteoarthritis. About how much does this cost? I would emphasize choosing your surgeon and not the approach. My problem isnt from a worn-down joint with no cartilage. Here are a few of the advantages of anterior hip replacement. I dont know what type of procedure was used for my first op but it was sucessful and now can do a half lotus position with no problem.I do find however that the muscles at the front of that leg are not as strong as my unoperated right leg and lifting the left leg to a vertical position in yoga, when lying on my back, is quite difficult. 1. Cons of Robotic Assisted Surgery As with any type of procedure, Mako is not without its drawbacks. 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 am totally confused and dont know which procedure to choose. 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. 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. Please do not take this as an attack, but your article seems biased on your experience (great results with min. Reconstructing the opposite hip hopefully will result in legs that feel more equal. What is your experience and take on this ? 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. Start your day off right, with a Dayspring Coffee SuperPath hip approach. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. posterior surgery . SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. Each approach you list has advantages and disadvantages. I feel that at 10 weeks with profuse denervation potentials on the quad muscles, the prognosis is not good, even at 6 months. Dear Dr. Leone, I am having Makoplasty ( robotic imaging) to my right hip in February. Thank you so much for your answer, I appreciate your taking the time to care about others. 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. During anterior approaches, fracture repair is much more difficult and necessitates the use of a separate incision.
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