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. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. Some in the early period have good track records, others do not. With a significant learning curve, it is likely that you will have to replace about 100 hips before you are truly comfortable with the approach. However disadvantages include the inability to adjust for leg length differences and a relatively high risk of femoral neck fracture. 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. Infection. 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. The vast majority of my patients have their surgeries with a simple spinal with IV sedation so they are sleeping throughout the procedure . An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. These can include damage to blood vessels or nerves, dislocation of the hip, and infection. I recently had a spontaneous hip fx and was diagnosed with hip displasia. Use of the forums is subject to our Terms of Use The most important variable is how quickly the person is motivated to return to work. The technique allows recovery that is as rapid as a mini-posterior approach while conferring stability of the hip joint that is equal to other exposures that . If possible, speak with other health professionals who work at the hospital or at least in the same geographical area. It exploits the inter-muscular interval between the tensor fascia lata and the gluteus medius. Clots can form in the leg veins after surgery. Many manufacturers are responding to the surgeons desire for shorter stems and many are now available on the market. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. Finally, hip replacement surgery is expensive and may not be covered by insurance. Is a prerequisite for THR to have a MRI or Pet Scan? However, I now have quite severe OA in my right hip apparently I have no cartilage left and have been told by a surgeon that I am just lucky not to be in constant pain. Have you ever performed the Mini on a patient 1 year after major open heart surgery? There is a possibility that blood loss may be reduced as there is less unnecessary exposed bone surface left to bleed. 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. I am scheduled for bilateral hip replacement at the end of August. Our overall findings suggested that the short-term outcomes of THA through SuperPATH were superior to DAA. I think researching the hospital where you will have your surgery is very important. I had an anterior approach hip replacement. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. I am now 59, still in good condition but that is being compromised by lack of working out as my hips get sore from most everything I try. I now need the right hip replaced. I am 37 and have suffered from AVN since I was 14. Read our editorial policy. Any feedback will be appreciated. DAA had a lower rate of hospitalization and functional rehabilitation as compared to the lateral approach, as well as a lower perceived level of pain. Patients understand the risks that metal joints and sockets bring to their long-term health and are moving away from the material. That being said, if the foot is now a much bigger problem than the hip, you may have to deal with that first. Dear Dr. Leone, It is also possible to have an anterior hip replacement during pregnancy. If so, how long until I can get back to normal living? After awhile the screws started shifting and poking up under the skin and they removed them. I have done everything I can think of to preserve my right hip, but sadly this too needs replacing. How do you ask your doctor the questions you want to ask? SuperPath approach is the least invasive due in part to the minimal amount of tissue damage. Possibly, its secondary to an altered gait pattern or hip mechanics. Back then my surgeon advised me to perform a posterior surgery as opposed to anterior saying that I was overweight, short and a very muscular person and it would be easier and safer to do so. Because the patient is lying on his back, it facilitates using a fluoroscope or moving x-ray throughout the procedure. Thanks. Are my findings that posterior approach in my situation would have been more appropriate? Upgrade to Patient Pro Medical Professional? 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. 2. I have insurance with very high deductible and I am scared of the debts I might incur afterwards too ( where I am planning to do it I might not have to pay any money). Thanks so much for your help, very grateful. . Behavior. Your article lacks the pros of the AMIS and the cons of min invasive posterior. I think tennis, dancing and horseback riding are fine. Im now 6 weeks out and doing good. I am already limping when walking and was hoping that the limp would disappear after the hip surgery. Adductors refer to a group of muscles that insert into the medial (inner) upper femur and often become contracted with an arthritic hip. 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. Specific protocols, therapy and what positions you will be asked to avoid after surgery and for how long will be directed by your surgeon. Two which are receiving the most attention are the traditional posterior approach and the direct anterior approach. One thing I do not want is any muscles or tendons cut in the procedure. Once you find that doctor, then you need to put your trust in him or her to help you solve this horrible problem so you can return to being active and productive. #1. If you do not want that we track your visit to our site you can disable tracking in your browser here: We also use different external services like Google Webfonts, Google Maps, and external Video providers. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. Ceramic-on-polyethylene is currently the most popular hip replacement material, representing 50.6% of all hip replacement cases back in 2014. With a bilateral procedure during a single anesthetic, the blood loss would be double and there would be a much higher likelihood that my patient would need transfusion post-operatively. About my surgery: I had to wait 30 hours before surgery, two days later I was released, within two more days I stopped using my walker. Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. I would like your opinion on the stem cell injections as I am really afraid of the second surgery on the same side of my body. The traditional posterior approach is the most commonly used in the United States and throughout the world (about 70 percent). If this occurs, the patient may experience pain and swelling. The parts may be attached to the bones in one of two ways. 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. I wish your patient well. Your back does need to be evaluated as well. I have been doing ALOT of research about the different approaches to THR and looking for the absolute best surgeon. Posterior hip surgery may be the best option if your surgeon makes a larger incision at the side or back of the hip joint. 2021 May 20;16(1):324 . During anterior approaches, fracture repair is much more difficult and necessitates the use of a separate incision. 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. When discussing the options, my surgeon all of a sudden suggested performing anterior approach. We can do this because of improved plastics. Its been 8 months now. I would encourage you to discuss your expected recuperation time and specific restrictions with your surgeon. About how much does this cost? By far the most important variable is the doctor who is doing your surgery and managing your post-op care. Have you heard of something like this, and if so, is it worth it? Do I have a risk of fractures during a posterior right hip revision due to my prior complications already? Does either procedure in this discussion present restrictions or advantages for this sort of movement? Hip dysplasia is a very common underlying cause of hip osteoarthritis. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. Dr Leone, you make the point several times that the surgeon, not the procedure is most important. They thought it would give me about 5 yrs. Soon my right hip started bothering me. Finally, hip replacement surgery is expensive and may not be covered by insurance. What is SuperPath hip replacement? Most of my patients now go home the day after their surgery or the next. Since then, SuperPATH has enjoyed excellent success. This complete wall of tissue that surrounds the new hip imparts stability. My first bike ride was 22 miles without any problems. Why is that? There are a few disadvantages to hip replacement surgery. I prefer spinal anesthesia when possible because fewer drugs are used and often the experience is gentler. What Ive seen in my practice is that the more total hips I do, the less restrictions I place on my patients and the more active my patients are. Dr. William Leone. If you refuse cookies we will remove all set cookies in our domain. Therapy is often appropriate for stretching, strengthening and electrical stimulation which helps maintain the motor end plates, structures on the muscles that the nerve branches must re-innervate. Recognize that the underlying etiology is not being corrected by this procedure, so relief of symptoms probably will be temporary and possibly partial. Having diabetes and two organ transplants does significantly increase your risk for post-op infection as well as other complications. Have you recovered by now? for Orthopedic Care 35 (2):153-62. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. Im an avid skier and just found out I did not have full Anterior but rather AL. Each question is scored from 1-5, with 1 being no problems and 5 being severe problems. The hip joint needs to be replaced again when it no longer works properly because of a revision surgery. People undergoing traditional hip replacement surgery, for example, are advised not to bend at the hip more than 90 degrees for approximately six weeks after the procedure. A shorter hospital stay and faster recovery are typical of this because there is less damage to the muscles. 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. Update what hes cutting is the adductor so my question is the same is this just a normal part of some THRs? I also would find out your surgeons recommendation regarding activities and restrictions. Proponents of minimally invasive hip replacement say small-incision operations can lessen blood loss, ease post-operative pain, trim hospital stays, improve scar appearance, and speed healing.. Thank you. Can You Use An Inversion Table With A Hip Replacement I choose to do them in a staged fashion because it is a significantly shorter procedure (more than half time-wise) and some think this lessens the risk of infection. Nobody wanted to talk 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. Every patient needs to have as limited an approach and dissection as possible that does not compromise the final implant position or create excessive trauma to the soft tissues. 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. We now have less-invasive techniques, better surgical methods of closing soft the tissue and more experience. 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? Doc says once recovered I should avoid flexion with adduction and internal rotation. What reasons would there be to use the regular over the mini? It's cut off and removed through the hole. Following surgery, the surgeon will devise a routine for the patient to engage in that is both comfortable and safe. Other preoperative guidelines, such as using a prescribed pain medication and keeping the incision clean and dry, should also be followed by patients. 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. Comparison of short-term outcomes between direct anterior approach (DAA) and SuperPATH in total hip replacement: a systematic review and network meta-analysis of randomized controlled trials. My surgeon wants to use the posterior approach and indicates that I eventually should be able to play golf again. But after reading your articles, I am hesitant about that choice now. I cant find anything that addresses replacing a hip that is dysplastic. Historically, higher dislocation rates were reported with the posterior approach, but it still was used for its many other advantages. There are many effective approaches and techniques that allow implantation of a total hip. I believe this is an important discussion you should have with your surgeon preoperatively. Patients who have this surgery no longer require walkers, canes, or other aids 5 to 7 days after the operation, in comparison to those who have hip surgery. 4 mts later am using I think it is important to define and isolate why youre doing so poorly. The femoral prosthesis is inserted into the hollow part of the femoral shaft. What are the experiences of other countries with THR? Disadvantages of the anterior approach include: The nerve which supplies sensation to the front and side of the thigh is vulnerable. Hip replacements might keep you out of action for a considerable period. I have been in pain for about a year and first though it was a back issue and it has limited my ability to stay as active as I would like. Hip anatomy No special surgical equipment is required when performing a mini posterior. 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. When done well, your body does well with this technology. We now have too many other proven bearing surfaces available. Thank you for sharing. 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! Pain and disability are reduced. Also, how about hip restructuring instead of Total Hip Replacement. Click to enable/disable essential site cookies. I wish you a full recovery. I advise both my total hip and my total knee patients to avoid repetitive impact activities like distance running. There is no way that you can recover fast from having bones cut and shaped and large metal objects inserted into them. Driving hurts too. It is critical to make the right decision regarding anterior hip replacement surgery in each case. J. Dear Dr. Leone, Because visualizing the femur is easier, an experienced surgeon can choose the most appropriate femoral implant rather than just the one that is easiest to implant, taking into account the patients bone quality, activity level and age. I weigh 185 and am 54 and realize its ideal to lose weight prior to surgery (working on it as always). Get Directions, Phone: 954-489-4575 Your frustration is completely understandable. Less tissue damage during surgery allows for a much faster recovery and no restrictions in range of motion when compared to traditional hip surgery. Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. These other conditions need to be defined and hopefully ruled out as the primary source of pain. An anterior hip replacement is not covered by a specific credential system for orthopedic surgeons. Overall, however, anterior hip replacement is a safe and effective procedure with a high success rate. I also would encourage you to choose your surgeon first not the procedure, approach or prosthesis. 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. Bleeding at the operative site can occur as a result of an anesthesia reaction, such as an allergic reaction. With SuperPath, there is no surgical dislocation of the hip. I then would strongly suggest you trust that person to decide what approach and what prosthesis predictably will deliver the best results. 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. from publication: Current and . Introduction. What determines the differences? I will let you in on something personal. as being in breach of those terms. We thank you for your readership. The most common type of total hip replacement is done in the anterior anterior part of the hip. If a revision were necessary, even more bone must be destroyed to remove it. Over time, untreated hip dysplasia or hip impingement can lead to arthritis and, eventually, hip replacement surgery. Procedures Notes on SuperPath experiences good or bad, https://patient.info/forums/discuss/superpath-experiences-good-or-bad-718788. This is described as a posterior approach because the actual hip . I would emphasize choosing your surgeon and not the approach. The art of surgery should mimic a well rehearsed ballet or symphony. Its from a malformation. 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. Because of the straightforward exposure of the femur, there is less risk of femoral fracture or poor implant positioning. Lateral femoral cutaneous nerve injury is the most common injury incurred during an anterior approach. The experiences will vary greatly . The most important decision you will make is choosing your surgeon. They may be: Cemented to the bone. I would rather my patient get half as much anesthesia. What do you consider to be the most important factors in choosing a surgeon? If you do not have a hip replacement, you will live a sedentary lifestyle and become overweight. Sometimes, when a surgeon is working too hard to reconstruct through a very small incision, the ends of the incision tear and the tissues are traumatized. Will I still be able to do the things I like to do? I feel that at 10 weeks with profuse denervation potentials on the quad muscles, the prognosis is not good, even at 6 months. My surgeon mentioned also cutting something to free me up at the same time he will be doing the posterior approach surgery. Each surgeon approaches these issues individually. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. Click to enable/disable _gat_* - Google Analytics Cookie. These are all realistic goals. My doc said the angle of my hips is not the worst but also not the best. Try our Symptom Checker Got any other symptoms? But this blog was a nice nudge toward the posterior. I was discharged within 24 hours. You can check these in your browser security settings. According to Dr. Gililand, patients should not try to change their surgeons opinion based on their preferences. 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. Stay was 2.5 days. I think there may be increased associated complications. 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. A mini posterior approach is a modification of the classical posterior approach. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. 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. posterior surgery . 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. After reading your article I am concerned about the issues you discussed. Contact Dr. Moor, Orthopedic Surgeon at Advanced Sports Medicine Center. I deal with major nerve damage on front of thigh, almost whole thigh. I am a very active and young 69 year old female who had a THR on my left side 5 years ago. There is less blood loss with a single THR than a bilateral, hence less risk of needing a transfusion. Some hospitals and surgery centers are promoting one method of hip replacement over another. Would you recommend treating plantar 1st? I just had mine 10/30 all I can say is be patient get lots of rest and take your pain meds way before you start to move around so that the pain want be so bad with movement. It is normal to want to recover quickly and return to a very active lifestyle without pain. The anterior approach, as a marketing tool, has grown in popularity among surgeons. Each approach you list has advantages and disadvantages. I think the money you spend to have a hip replacement is more than just moral or justified, it is smart business. After all, no matter the age, it will determine the likelihood of maintaining your mobility and independence. A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). results, I decided to see and orthopedic doctor was advised to have THR.