This treatment is commonly recommended for patients suffering from osteoarthritis of the hip. Thanks for any feedback. I definitely would not recommend a hip scope and THR during one anesthetic setting. 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. These are all realistic goals. 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. The questions youre asking are 100 percent appropriate. That being said, in order to meet your goals, if need to leave your area and consult with surgeons in other areas, I think that is reasonable also. The first is that it is a major surgery, so there is a risk of complications such as infection. Risks associated with hip replacement surgery can include: Blood clots. Posterior, mini posterior or anterior? 2. As a result of the interventions, the surgeon has a better view of the hip joint. Im so pleased to learn that you had a good experience. I am seriously looking at the infection rate at each facility. Can you explain it to me as he didnt go into detail. As for doctors, the surgeon I had came highly recommended. How would a hip replacement be done? 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. By far the most important variable is the doctor who is doing your surgery and managing your post-op care. In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. Very slow recovery. Had arthroscopy in Jan 15, cleaned up tear and arthritis. Dr. Robert Sigmund is a board-certified orthopedic surgeon and a sports medicine physician based in St. Louis, Missouri. SuperPath hip replacement is a newer method and has been used since 2019 at Leicester's Hospitals. On July 17th, I had a left THR. So my question is in relation to my body structure. 2021 May 20;16(1):324 . That's all I know. I am experiencing pai. I recently had a spontaneous hip fx and was diagnosed with hip displasia. I had good results into 5th month post op and then everything went downhill. Because the patient is lying on his back, it facilitates using a fluoroscope or moving x-ray throughout the procedure. 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. With degenerative osteoarthritis of the hip developing secondary to a severe slipped capital femoral epiphysis (scfe), recreating normal hip mechanics after THR may have necessitated lengthening the first hip. I have a good surgeon (same one as last time) but I dont know how he would feel about my asking if a mini posterior (or posterior) procedure be carried out, so as to preserve as much strength in my right leg as I now have.Do as many muscles need to be cut in the mini posterior procedure? I am not sure that is true any more. I have seen 2 doctors one doing posterior, the other anterior. I ask my patients to restrict certain positions that exceed the mechanical limits of the artificial hip for the first six weeks. What are your thoughts with regard to Stem cell therapy in lieu of THR? The traditional posterior approach is the most commonly used in the United States and throughout the world (about 70 percent). Start your day off right, with a Dayspring Coffee But this will always prompt you to accept/refuse cookies when revisiting our site. 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 femur is prepared with the head and neck intact reducing the chance of fracture. Sometimes, it simply isnt possible to accomplish. One of the potential disadvantages is that because the surgery is performed through the front of the hip, there is a risk of damaging the hip joint and the surrounding muscles and tendons. 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. There are various ways of doing a hip replacement. Sometimes the pain goes away as I walk and sometimes it doesnt. The new femoral prosthesis and new socket . Rather, they say Bill, please just do what you have to do and do a great job. This is actually a good sign. Doctors use metal, ceramic, or plastic replacement parts. The hip is replaced without the need for surgery to dislocate the joint. It is normal to want to recover quickly and return to a very active lifestyle without pain. As of 2020 only Dr. Leone is using the latest hip technique called the. Also, the surgeon said that I would end up having one leg shorter than the other is this true? Click to enable/disable _ga - Google Analytics Cookie. Regarding restrictions after your hip replacement, this too is an area that has changed drastically over my 25 year career. Can You Use An Inversion Table With A Hip Replacement From what Ive seen, most THR patients dont need very much PT, although I do encourage exercising in a pool. The incidence of dislocations has further decreased over the past decade with our ability to implant larger size femoral heads. Hip replacement - Doctors & Departments - Mayo Clinic With SuperPath, there is no surgical dislocation of the hip. Why is that? They thought surgery to repair it would give me about 5 yrs. Do I have a high percentage of hip dislocation after a 2nd revision done posterior way if so what is my chance of another hip dislocation even if I do the surgery again? I live in the UK so again Im afraid I wont be able to consult you personally! It does sound as if proceeding with a THR is appropriate, since your attempt to repair the joint arthroscopically did not pan out. Dear Dr. Leone, Sex After a Hip Replacement: Positions, Tips, and More - Healthline Hip replacement - Mayo Clinic My doc said the angle of my hips is not the worst but also not the best. Minimally Invasive Total Hip Arthroplasty Technique - Medscape I also would learn about the track record of the surgeon and hospital where you will decide to have the surgery and what implant will be used. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. July played my last match when I buckled. These other conditions need to be defined and hopefully ruled out as the primary source of pain. Not only was my recovery twice as fast with the anterior, there was very little pain in comparison. I was discharged within 24 hours. 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. 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. Unfortunately, injury to the lateral femoral cutaneous nerve is a common complication after the anterior approach for hip replacement. 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. Our team of experts, doctors, and orthopedic specialists are here to share their knowledge and experience with you in order to help you make informed decisions about your health and well-being. By continuing to browse the site, you are agreeing to our use of cookies. 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. But I am now in chronic low grade pain thats getting worse and dont know what I should do. I had an anterior right hip replacement in late 2010, I was 72. I deal with major nerve damage on front of thigh, almost whole thigh. I am 63 years old, 54, 115 pounds. If it is from intra-articular hip pathology such as osteoarthritis, which is very common especially in your age group, then most likely stem cell injections will not be affective and you would benefit from a total hip replacement. Other health issues include congenital heart ASD corrected about 12 yrs ago with an amplatzer occluder implant by the right femoral approach resulting in possible femoral nerve compression, Lateral right leg numbness and leg discomfort since the implant, Groin pain and restriction in extending the right leg back has been a problem for some time and masked the fact that at least a portion of my increasing pain was from my hip. Many also mate this with a ceramic femoral head. 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. THOUGHTS? My legs are very muscular and trim. Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. There tends to be a lesser incidence of posterior instability with the anterior approach. Im so against any other replacements as I have other issues, but working with alternative treatments, out of pocket money, as my hip replacement has been a horrible drama/saga. THR if a MRI or Pet Scan isnt done? We now have too many other proven bearing surfaces available. I'm scheduled for THR on the 22nd. Three Cons of Hip Replacement Although total hip replacement is deemed a very safe procedure, there are associated risks that patients need to be made aware of before surgery. What to Expect 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? Advanced Ortho Surgeons | SuperPath Hip Replacement I have a tilted sacrum, sway back and a very large posterior. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. My main concern is that I have a tilted sacrum and a very sway back. I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. My husband tells me that I cry out in pai as I turn over during the night. Many modern-day femoral stems are considerably smaller or more bone sparing than well-functioning stems of the past. I really appreciate this website. The first step to rule out infection is to have two simple blood studies done, an ESR and CRP. Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. They thought it would give me about 5 yrs. 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. Following anterior hip replacement surgery, avoid soaking in hot tub, sauna, or swimming pool immediately after surgery. My doctor does the Posterior approach, he didnt say anything about the mini part. I have the hospital but am deciding on the surgeon and which approach is best. not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in It is important that the individual who ultimately implants your next THR uses the approach which he or she feels comfortable with and has the best chance to deliver the optimal result. 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). Is Less-Invasive Hip Replacement Best for You? - WebMD Can you explain this approach? I thought the newer procedure on the special table was the best way to go. I just saw a patient with a femoral neuropraxia after a anterior approach THR. The hope is that these new designs will, but time will tell. I am feeling like this is a business like everything is else. Patients are told how to use their hip after hip replacement surgeries, which is very different than the usual practice. Six weeks or longer is the exception. A hip replacement is the most common cause of complication in about 20% of cases. 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. My husband has a plastic valve (done in 86) and synthetic assending aorta and triple bypass (done in 2013)very successful surgery. 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. Fortunately, the incidence of hips dislocating after THR is very small, especially after first-time hip replacement. It is 100 percent normal and expected to be scared before surgery. This interval must be developed and the muscles must be separated in order to reconstruct the hip. Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. Orthop Clin North Am. Historically short press fit stems have not done well. The initial recovery period typically takes six weeks or more. There is a possibility that blood loss may be reduced as there is less unnecessary exposed bone surface left to bleed. Hard-on-hard bearings, such as ceramic-on-ceramic as well as metalon-metal articulations, also resulted in larger femoral heads being implanted. Between your legs, you should sleep with a pillow for the next six weeks. Additionally, there is a small risk of dislocation after surgery, which can be painful and may require additional surgery to correct. Surgeons do not cut across muscles. SuperPath approach is the least invasive due in part to the minimal amount of tissue damage. 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! Lift your knee rather than your hip at the same time. I had my hip scoped which bought me 8 years, but need a THR now. It is important to consider the SuperpathTM technique if you are considering a hip replacement. Also, when a single joint is replaced versus bilateral, there is significantly less bleeding and hence a much decreased need for transfusion. Maybe someday our nations health care system will measure up to that of France, Norway, Switzerland and others, in which their governments are investing half of the GDP that we are wasting. 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). You should not proceed unless you know in your heart that you will be taken care of in a manner that has the best chance of giving you as perfect a result as possible. I dont know what happens on that tablewas he in a hurry on Friday afternoon. As a result of anterior hip surgery, there is little need for any special care. All rights reserved. After awhile the screws started shifting and poking up under the skin and they removed them. The anterior approach has a lower incidence of sciatic nerve injury and a higher incidence of femoral nerve injury. This allows you to resume normal daily activities quickly while also returning to normal range of motion and function. Some people may find that traditional hip replacement surgery is the best option for them, while others may prefer a minimally invasive procedure. Operating through too small an incision and not releasing tissue that would improve exposure and result in a more balanced joint in my opinion does a disservice. 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. Dr. William Leone, Hello Dr. I went with a total hip replacement. No special surgical equipment is required when performing a mini posterior. 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. I assume its something near my groin. 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. A major muscle is not cut during anterior hip replacement surgery, so pain is reduced and major muscles are not cut after the operation. Dr. Tom Miller gives you the five best options for hip replacement surgery. Help. Although Superpath hip replacement is often a safe treatment, it may be associated with certain concerns, such as increased postoperative pain, as with any surgical procedure. SuperPATH showed better results in decreasing operation time, incision length, intraoperative blood loss, and early pain intensity. Most THR patients do not need significant supervised physical therapy after surgery; they simply do well when their surgery is done well. Hello Dr Leone, Most doctors have and continue to implant hips through the posterior approach. disadvantages of superpath hip replacement. Excess weight causes a hip joint that has already been stressed to become more painful and disability-causing. I would not recommend pushing your surgeon to use one specific approach or another. Most of the restrictions are removed at that time, although I still advise common sense, particularly for the first three or four months. Avascular Necrosis AVN of the femoral head happens when part of the ball at the top of your thigh bone loses blood supply, causing that segment of bone to die. What is most important is that you find a surgeon who understands the particular complexities with your problem and whom you trust. Would you recommend treating plantar 1st? It helps the surgeon implant the acetabular component in a very precise position. It is important to understand that "less invasive" does not only refer to the incision but . I still have a very big limp and still undergoing physical therapy. My gait is off partially due to my hip but also I believe because of my body structure. More likely, its because ones activity increases after the first THR. No groin pain NOW.but all the other mess of it all. Because these cookies are strictly necessary to deliver the website, refusing them will have impact how our site functions. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at [email protected]. In the case of a worn or damaged ball and socket, artificial parts can be used to restore joint function. You can be successful by staying healthy by sticking to less pain. If I think you may be a candidate, I will refer you to a doctor in our area that does. 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 would not change the position of the components. Many of these stems have very little if any long term follow-up, although some appear to be doing well in the short term. My doctor does not do mini posterior, therefor I have a 6 incision. Brandon Callahan, MD is a board-certified orthopedic physician with a decade of experience in providing comprehensive orthopedic care to patients with musculoskeletal injuries and disorders. 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. 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. Its been a nightmare for me going into 4 yrs post op soon. An anterior approach hip replacement is one of the most minimally invasive surgical options for replacing a hip. . These parts have a porous coating that the bone grows into. Enhanced soft tissue techniques also have been developed which more securely close the tissue around the newly placed prosthesis and set the stage for healing. My hope is that some of these symptoms will improve with time. Obese or extremely muscular people may not be the best candidates for this surgical procedure. Dr. William Leone. These are some of the most grateful patients in my practice. Please comment. Does the mini posterior hip replacement conserve more femur and allow for future surgeries if needed ? Possible Infections Dr. Sutphen: A minimal number of surgery patients (roughly around 1%) can develop an infection around their hip replacement. Try our Symptom Checker Got any other symptoms? [QxMD MEDLINE Link]. The surgical area of anterior hip replacement is located in the vicinity of the lateral cutaneous femoral nerve. I wish you the very best, With much respect I look forward to your reply. I would also like to know about the customized implant, as I havent yet heard much about it. I understand they have good results in Thailand or India for half that. Im hoping to play tennis, go dancing and horseback riding once Ive healed. Very sorry to hear of the difficulties you experienced! It all comes down to the surgeons comfort as well as the patients. 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. SuperPATH Total Hip Replacement Phoenix, AZ | Total Hip Replacement Arizona The rest is marketing. I am scheduled to have total hip replacement surgery in 2 weeks. I also have undiagnosed neuropathy in both legs from the knees down. 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. The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior Does it really not matter which approach I have, posterior or anterior? I play in the 50s age group. What do you mean by painful anterior scarring and soft tissue exposure and trauma? Thank you for sharing with others the nerve supplements that youre finding affective. I have had problems with my hip for the last several yrs. Introduction. 1. While new techniques, instruments and prostheses have been developed specifically for minimally invasive surgeries, there are many well-established approaches to hip replacement. Complications associated with an anterior approach hip replacement are similar to those associated with standard hip replacement surgeries. It will help desensitize and help get your muscles working in synchrony. I havent dropped in here for a while but here I am almost 5 yrs post op Anterior and Femoral Nerve Damage is very alivewhole thigh is numb, IT band is still very sore and numb. Back to work/driving in 10 days. 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. Even if the hip doesnt dislocate, prosthetic or soft tissue impingement is not beneficial. results, I decided to see and orthopedic doctor was advised to have THR. Ten years ago I had total hip replacement on the left at hss. what is the super path method I've never heard of that before, superpath is just the fancy name for a smaller incision , less trauma and quicker recovery or so they say from what I have read along with more surety of the length of leg . An anterior hip replacement is not covered by a specific credential system for orthopedic surgeons. Therapy hopefully will help any contractures and scaring within your muscles that might have developed after surgery. I think tennis, dancing and horseback riding are fine. Do you also do arthroscope surgery? In my experience, most patients who undergo a total hip replacement dont limp after their surgery and most feel their legs are the same length. With mild dysplasia, positioning and implanting the new cup usually is not more difficult than with other conditions. Glad that after lots of PT and massage and medial branch block for back issues with NO!!! Femoral nerve function also should be assessed. Fax: 954-489-4584 Can you compare/contrast to the other approaches; posterior, mini posterior, anterior? In Dr. Lawrence Dorrs opinion, doctors and hospitals should not market a specific type of surgery as the most effective. 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. There is also a small risk of death associated with any surgery. We can do this because of improved plastics. I have done everything I can think of to preserve my right hip, but sadly this too needs replacing. A orthopedic surgeon may insert a numbing agent directly into a new joint, which can last up to 48 hours. 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. So frustrating. It's a hip replacement surgery where you lie on your side. Its been 8 months now. The size and placement of the incisions will be different. External rotation of your feet should be limited (avoiding them twisting to the outside as Charlie Chaplin does) and hip hyperextension should be avoided. I dont want a long recovery time as I am very active. Following the anterior approach, we provide you with a number of precautions and positions that you should avoid if you are in danger of being discomfited. I suspect there is significant underlying osteoarthritis related to your labral pathology. Need to choose, then select doctor based on that decision. I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. (I have SCD) It has now become unbearable and I am preparing for surgery.