I think they are happier and rehab more quickly. Thank-you. Is AL better than P for this? The source of your hip pain must be diagnosed. Today, everything from tools to techniques has improved. Very slow recovery. Apples to apples which procedure has the lowest incident of complications? I very rarely transfuse any patients now. The femoral prosthesis is inserted into the hollow part of the femoral shaft. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. The first is that it is a major surgery, so there is a risk of complications such as infection. Complications associated with an anterior approach hip replacement are similar to those associated with standard hip replacement surgeries. When a dysplasic hip is reconstructed to THR, its important the abnormal mechanics are corrected, typically by medializing (closer to the midpoint of the body or bladder) the cup. They thought it would give me about 5 yrs. It is also important to avoid any sudden movements or twisting motions. I am about to have a hip replacement and would like to know what kind of limitations Ill have afterward. 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. The posterior approach is used by a small percentage of people. Because the patient is lying on his back during the procedure, fluoroscopy or moving x-rays are used to aid in the examination. The approach planned is a frequent topic of Continued Dr. Robert Sigmund is a board-certified orthopedic surgeon and a sports medicine physician based in St. Louis, Missouri. Soon my right hip started bothering me. Thanks so much for your help, very grateful. You can check these in your browser security settings. Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. Your symptoms still sound mechanical, positional and episodic. Even in my practice, which is starting its 27th year, we continue to refine the surgical procedure, pre- and post-operative instructions and rehab (this is huge), pre- and post-operative pain management, and even anesthesia. I think it perfectly ok to discuss different approaches and ask for an opinion. The doctor has scheduled me for total hip replacement in two weeks and he uses the Posterior approach, he didnt say anything about the mini part. It seems reasonable and I trust my surgeon but would like to know what I'm in for post op and beyond. Clearly, he or she has earned your respect and confidence. I recently had a spontaneous hip fx and was diagnosed with hip displasia. I am experiencing pai. These stems are a new design, and therefore do not have an established track record. I'm scheduled for THR on the 22nd. Hip replacement surgery can open up a world of possibilities for people who have lived with pain and restricted movement. It can lead to numbness in the thigh and, in rare cases, skin irritation due to the nerves presence. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. As a result of the interventions, the surgeon has a better view of the hip joint. 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. Some people also tend to form scar tissue and contracture more readily than others. I didnt spend time on boards talking for eons about peoples outcomes.probably a good thing I didnt. I had a posterior, the surgeon did not cut any muscle, they just move them now. Studying a hospital and physicians track record before you commit is important. I suspect there is significant underlying osteoarthritis related to your labral pathology. Typically, the new cup will be medialized to gain coverage and correct the abnormality that lead to your arthritis. I think it perfectly ok to discuss different approaches and ask for an opinion. What is SuperPath hip replacement? There are many factors that contribute to whether or not someone is a good candidate for anterior hip replacement surgery. I wish you the very best, United States. Because my husband has circulation problems in his leg and vein removed for open heart surgery last yearhis surgeon recommended the Mini posterior surgery. Also, if a surgeon knows in advance that a certain range of motion is desired, can they provide some adjustment in surgery to help accommodate that desired movement? Patient Concerns I think it was sensible being careful on the other hand and I was told not to cross my legs. Blog So my concerns include having the range of motion to perform moves like promenade where my body is roughly facing forward and my right leg will take a step left across my body at about 90 degrees. I am looking at how many hips they have done and where they are doing them. I did have a total knee replaced two years ago. 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. Does the mini posterior hip replacement conserve more femur and allow for future surgeries if needed ? Some people may find that traditional hip replacement surgery is the best option for them, while others may prefer a minimally invasive procedure. The other things that can affect the op is your fitness beforehand, your attitude and your age, although you may have difficulty getting younger!! 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. I am still a very active 67 yr old, I like to ski, bike, hike (steep terrain) with about 25 pds. If you are minimally handicapped with discomfort from the non-operated hip and the leg length difference is tolerable or easily managed with a shoe lift or modification, I would consider waiting. The posterior approach for hip replacement surgery is by far the most common surgical technique used in the United States and throughout the world. The rule of thumb is that recovery occurs over a 12-18 month period following injury. Infection. 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. 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. In 2013 I had a THA done on the left hip. Im hoping to play tennis, go dancing and horseback riding once Ive healed. Your blog on anterior vs posterior approach was very informative. Even if the hip doesnt dislocate, prosthetic or soft tissue impingement is not beneficial. The last page is asking the participant to self score their health that day out of 100. If your surgeon has recommended surgery, I assume youre no longer getting adequate relief of pain or able to remain active with conservative measures. Having a THR is a major undertaking and it is reasonable to expect the hip construct to function optimally for twenty and more years. 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. But this will always prompt you to accept/refuse cookies when revisiting our site. It is critical to consider the pros and cons of each option before making a decision. It is important that you find a doctor who is experienced in caring for people with complex issues. If this occurs, the patient usually requires a total hip replacement. Select a surgeon based on your impression of that individual: how engaged was he or she in your care, will you have access to that person as well as his or her team before and after surgery? My surgeon does the SuperPath method. It allows the surgeon to work between the muscles and tendons without removing them from their anchoring points on the hip or thighbone. 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. I began using the superior approach for total hip replacement in February of 2014. . Woke up with Part of those possibilities includes a better and more comfortable sex life. Anterior hip replacement is a type of hip replacement surgery. People who have anterior hip replacements tend to stop using walkers, canes, and other aids 5 to 7 days sooner than people who have conventional hip surgery. Our overall findings suggested that the short-term outcomes of THA through SuperPATH were superior to DAA. Most patients are able to walk the day of surgery. 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. When the joint is held together by gravity and asymmetric anterior muscle tension, the tension between the ball and socket may change in various directions. Thank you, Lisa. I find it curious that you report having a good result for the first five months after your surgery as this suggests that the surgery was done for the right indication, i.e., you did well and were pleased for the first five months after THR. 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. The particular surgeon who did your hip is also uniquely qualified to advise you with regard to the postoperative stability of your particular hip, because he or she physically tested your hip intra-operatively. What reasons would there be to use the regular over the mini? Its been 9 months(Ive had it 2xs bf and got rid of it and have tried everything and no results this time). Hello Dr Leone, For the prevention, diagnosis, and treatment of hip pain and other problems affecting your hips, call Advanced Sports Medicine Center today at (941) 957-1500. There arent any activities that you can do with a resurfaced hip that you cant do with a total hip. Dont let PR marketing confuse the big picture. I was thinking of doing that 1st, maybe April(Ill be in boot 4 weeks), and then the PTHR in either Sept or next Jan when I have free time. I walk a lot in my job and bend lots (work with children) and sitting causes pain due to impingement. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. Clearly, he or she has earned your respect and confidence. 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. Fortunately, the incidence of hips dislocating after THR is very small, especially after first-time hip replacement. I believe going home is very therapeutic and often safer. Your article has made it clear I made the correct decision, especially since my daughter had nerve damage from an operation years ago. As of 2020 only Dr. Leone is using the latest hip technique called the. I also would encourage you to choose your surgeon first not the procedure, approach or prosthesis. Upgrade to Patient Pro Medical Professional? The SUPERPATH technique is a tissue-sparing procedure. 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. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. I was not aware that any of the local surgeons who is doing anterior approach. Only Dr. Leone will be using the most recent hip technique known as the SPAIRE technique as of 2020. I would discuss fully your goals and concerns. Need to choose, then select doctor based on that decision. For many years, I performed bilateral THR and bilateral TKR procedures, but have backed away for a variety of reasons. Currently we use standard ways, called either posterior or direct lateral approach. Lastly, if one has had P or AL is there anything that can be done to offset the need for restricitons? I am scheduled for bilateral hip replacement at the end of August. Introduction My main concern is that I have a tilted sacrum and a very sway back. Thank you, Lisa Blumthal. Length of hospital stay with SuperPath hip replacement approach. You helped me tremendously in my research of the track record of my HMO, now I have one more quick question to run by you. Hip dysplasia is a very common underlying cause of hip osteoarthritis. My advice is to have a frank discussion with your surgeon and share these concerns. Patient is a UK registered trade mark. I assume PTHR is referring to partial hip replacement. The most important decision you must make is choosing your surgeon. What surgical approach is typical for a complex total hip replacement? I spoke in person to probably 4-5 of his success patients and went with hearing from them. 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. Excess weight causes a hip joint that has already been stressed to become more painful and disability-causing. 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. I also think its reasonable to look forward to returning to all of the listed activities that you enjoy. Read our editorial policy. They thought surgery to repair it would give me about 5 yrs. I also think infection must be investigated and ruled out. I had an anterior approach hip replacement. Adductors refer to a group of muscles that insert into the medial (inner) upper femur and often become contracted with an arthritic hip. Since then, SuperPATH has enjoyed excellent success. Femoral nerve function also should be assessed. With the ease of movements during pregnancy, you will be able to move around more freely. 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. Hip replacement is a fantastic operation that can help relieve pain, improve daily function, and improve quality of life. 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!" Thanks. It normally takes about 3-6 weeks to resume normal household activities and about 12 weeks to resume recreational activities like bicycling or golfing. Most patients decide not to wait as long to have their contralateral hips or knees replaced after having undergone a successful surgery on the first side. I thought the newer procedure on the special table was the best way to go. I have been in excruiting pain and unable to do everyday normal activities. Also, after an accident, I had 12 screw and an L shaped plate in my heel. I would anticipate that you would be able to return fully to your activity once the tissues around your total hip heel. Here is his perspective based on careful observation of outcomes. This robotic technique can assist in producing an excellent result. I understand they have good results in Thailand or India for half that. I wish you luck on your journey. Im considering this mini posterior approach. No groin pain NOW.but all the other mess of it all. Above the ankle to the thigh.Had to use leg brace to What do you mean by painful anterior scarring and soft tissue exposure and trauma? I believe choosing your physician is the most important decision you can make. In my experience, after four to six months most patients simply return to normal activity. 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? Raleighs orthopaedic clinic is board certified and has fellowship training in total joint replacement. I wish you a full recovery. One disadvantage to the mini posterior approach is that patients are instructed not to place the newly implanted leg in certain positions for the first six weeks after surgery. I have been told that I can fly 48 hours after surgery?? Also, only a small percent of C-on-C bearings are being implanted at this time. Thank you, Rita. I would stay away from narcotics. more nutritious, too. I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. 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. A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? A femoral nerve injury is devastating and is more vulnerable during an anterior approach than with other approaches. DAA and SuperPATH were equal in functional outcome and acetabular cup positioning. All: It was also observed to be associated with longer surgery times. 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. Dear Mary, I would encourage you to discuss with your surgeon the difficulties and pain you experienced after the first surgery, and together explore if another plan can be created for a better outcome the second time around. 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. The incision made for the operation can be as small as three inches. I encourage you to do the same. J. Dear Dr. Leone, There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. 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. Thank you for sharing. These scores are not aggregated. He is the founder and main author of brandonorthopedics.com, a website that offers valuable resources, tips, and advice for patients looking to learn more about orthopedic treatments and physiotherapy. Dr. William Leone, Hello Dr. My strategy is to make as small an incision as possible, but one that allows for excellent exposure and reconstruction without brutalizing the tissues. The questions youre asking are 100 percent appropriate. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. Our insurance covers both. Gary. Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. The following cookies are also needed - You can choose if you want to allow them: You can read about our cookies and privacy settings in detail on our Privacy Policy Page. Most individuals who have had total hip replacement surgery fall into this category and simply resume their lives.. These other conditions need to be defined and hopefully ruled out as the primary source of pain. Is the hospital where the surgery will be performed also top rated?. What are your thoughts with regard to Stem cell therapy in lieu of THR? Click to enable/disable essential site cookies. I have had problems with my hip for the last several yrs. I sit on a cushion in the car to lift me up. If possible, try to get in writing any verbal promises made. I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. For centers like Phoenix Spine and Joint that use a robot, there is . I am not sure that is true any more. I do participate in competitions and showcase presentations. You can do anything you want after a hip replacement. This complete wall of tissue that surrounds the new hip imparts stability. A hospital outpatient surgery can cost between one-third and one-half the cost of an outpatient surgery atCOSC. Registered in England and Wales. I wrote to you in January, now my surgery is in a couple of weeks. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. Check to enable permanent hiding of message bar and refuse all cookies if you do not opt in. According to Dr. Gililand, patients should not try to change their surgeons opinion based on their preferences. I'm hoping to read some posts post surgery. Dr. I think its vitally important that you go into surgery truly believing in your heart that you are going to do well, and that you are with the best surgeon and team who will help you. This technique avoids cutting muscles and tendons, minimizing surgical trauma and improving the post-operative experience. My walking is very limited, shoe is built up as leg is shorter and in recent months Ive realized my leg is bowed. as being in breach of those terms. What is most important is choosing your surgeon. It is nice to see honest Q&A versus a marketing page. I saw a hip surgeon last year for an opinion, but because I had almost no arthritis on the x-ray he said he saw no need for surgery. Obese or extremely muscular people may not be the best candidates for this surgical procedure. I understand and respect that many surgeons prefer doing them simultaneously. 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. Ill be 60 at the time and Im 54 and weight about 130 lbs in fairly good shape. Hip replacements might keep you out of action for a considerable period. Years!! SuperPath hip approach. I typically do hip replacement on the get anterior approach in 90% of my patients. Hospitsl staff emergent norm theory quizlet. Also, some body structures or anatomy makes approaching a hip anteriorly much more difficult than others. Time will tell if this generation of shorter press-fit stems fares as well. Going in for THR in July. Less tissue damage during surgery allows for a much faster recovery and no restrictions in range of motion when compared to traditional hip surgery. Disadvantages of the anterior approach include: The nerve which supplies sensation to the front and side of the thigh is vulnerable. Due to security reasons we are not able to show or modify cookies from other domains. In general, I would encourage you to consider all of your prosthetic joints a remarkable modern day miracle that must be cared for and respected. I am 63 years old, 54, 115 pounds. There is no definitive answer to this question as different people will have different opinions and preferences. Try our Symptom Checker Got any other symptoms? Does anyone ever attempt to do both at the same time if THR is determined? I would encourage you to discuss your concerns with you surgeon. SuperPath approach uses about a 3-inch incision at the side of . Yes, Im angry. Also congenital pulmonary hypertension (PA pressure about 52) and have hashimotos hypothyroid, and two additional auto immune issues ( alopecia and psoriasis of feet),and hypertension. The hip replacement needs to correct the abnormal hip mechanics that lead to the arthritis. Thanks for giving us patients the kind of information we need to be more educated as to what questions to ask. I am a competitive tennis player in my age division. I decided to stick with my trusted orthopedic surgeon (who did two knee scopes on me) who believes the minimally invasive posterior approach is the safest approach. Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website. Our second opinion doctor performs traditional and Birmingham hip replacement. I am just under 5 ft and weigh 185. If you decide to have your hip replaced in another country, I would consider carefully who would care for you if you develop a complication such as an infection, or a major medical problem like a pulmonary emboli or heart attack after surgery. Really Great. I had to cut some strength exercises out leg lifts, hip sled. 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. In 2014 I had to do another THA, this time on my right side. and Privacy Policy and steps will be taken to remove posts identified Hi guys im 43 and live in Australia and due to have hip replacement in 7 weeks but im so confused as my surgeon is doing the posterior and im off work for 6 weeks where i here people having the anterior and going back sooner and no restrictions on hospital discharge any advice. Im 56 years of age, 6 1 and 180 pounds. These can include damage to blood vessels or nerves, dislocation of the hip, and infection. Many times, the depth of the destruction that is found during surgery is much more advanced than initially anticipated, particularly as we age. In my experience, the restrictions (or those positions we ask our patients to avoid after surgery) have become much less limiting and are off limits for a much shorter period of time. I had my hip scoped which bought me 8 years, but need a THR now. I just want to thank you for the information on this site. 2012 Oct 17;94(20):1897-905. doi: 10.2106/JBJS.K . Historically, higher dislocation rates were reported with the posterior approach, but it still was used for its many other advantages. Other jobs, which tend to be more structured and / or more physical, may require more time off. Behavior. Since 1995, there has been an extremely low dislocation rate and an infection rate of zero percent. In another day I was able to take short walks without any limping, etc.. The SuperPATH technique is arguably the least invasive hip replacement technique. With SuperPath, there is no surgical dislocation of the hip. Hi, I assume its something near my groin. One of the biggest changes that Ive seen in my practice over the past 25 years is how quickly patients get well and go home. 2. My second question relates to something you mentioned earlier regarding checking the published track record of the surgical team if I use an HMO, how do I find that information, and how do I know it hasnt been skewed to give more favorable results (lying with statistics)? A long surgery time, on the other hand, was also associated with DAA. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. Notes on SuperPath experiences good or bad, https://patient.info/forums/discuss/superpath-experiences-good-or-bad-718788. Share your concerns with your surgeon. I still have some questions I hope you can answer as this is so distressful for me. It also keeps the surrounding muscles and tendons in place to reduce the risk of post-op pain and nerve damage. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. Its also reasonable to ask to speak to other patients who have undergone THR using this technique to learn about their experiences and results. Your frustration is completely understandable. Will meet with doctor soon but when I was finally able to really exercise after surgery I overdid it and developed plantar fasciitis. A hip replacement can be delayed until it is absolutely necessary if the replacement parts can fail over time. A shorter hospital stay and faster recovery are typical of this because there is less damage to the muscles. The experiences will vary greatly . 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. The hip joint can be supported by the socket, which is designed to fit over the ball and provide stability.
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