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. I also would encourage pool walking or swimming. It is important to understand that "less invasive" does not only refer to the incision but . Seeing that a THR is considered major surgery, my question is, should I have my left hip done sooner than later to address the length difference or wait until I can no longer tolerate the pain? Also, when a single joint is replaced versus bilateral, there is significantly less bleeding and hence a much decreased need for transfusion. Advanced Ortho Surgeons | SuperPath Hip Replacement Ultimately, you and your surgeon should discuss all procedures and technologies available and then trust that your surgeon will choose the best course of treatment and surgical procedure for you. It seems reasonable and I trust my surgeon but would like to know what I'm in for post op and beyond. I wrote to you in January, now my surgery is in a couple of weeks. Total hip replacement is one of the most successful operations ever developed and is a remarkably predictable way to relieve pain from arthritic conditions. Dear Dr. Leone, Notes on SuperPath experiences good or bad, https://patient.info/forums/discuss/superpath-experiences-good-or-bad-718788. 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. invasive posterior vs not so good with AMIS) whilst on the other hand, with one of your replies you state that surgeon experience should be considered with AMIS success rates and in other replies stating that both alternatives are good. Dear Dr. Leone, The most important thing is to get a top notch surgeon and go with whatever approach they offer. About how much does this cost? I encourage my patients to talk to other patients for whom Ive cared and learn about their experiences. If your X-rays reveal that you already have bone on bone due to osteoarthritis, then you typically dont need either an MRI or Pet Scan, unless another diagnosis is suspected. The mini posterior approach works wonderfully and predictably when expertly performed. The anterior approach has a lower incidence of sciatic nerve injury and a higher incidence of femoral nerve injury. I had the mini-posterior at MGH hospital. Each surgeon approaches these issues individually. In my experience, almost all patients who have bilateral THRs go to rehabs and not home. Over the last decade total hip replacements have been performed using 2 main approaches: The posterior approach in which the hip joint is approached from the back by releasing and reflecting the short external rotators and dividing the capsule at the back of the hip; and the anterolateral . I began using the superior approach for total hip replacement in February of 2014. . SuperPATH Total Hip Replacement Phoenix, AZ | Total Hip Replacement Arizona 35 (2):153-62. I tore my labrum at age 43 and only discovered then that I had bilateral dysplasia. The big difference in anterior vs posterior hip replacement is primarily where the incision is made and how long it is. Hey, thanks for the forum topic.Thanks Again. 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. 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. Blog Bleeding at the operative site can occur as a result of an anesthesia reaction, such as an allergic reaction. 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). Recognize that the underlying etiology is not being corrected by this procedure, so relief of symptoms probably will be temporary and possibly partial. If your surgeon has recommended surgery, I assume youre no longer getting adequate relief of pain or able to remain active with conservative measures. Low-risk anterior approach patients are those who have significant deformities in their proximal femur as a result of previous trauma or dysplasia, or who have previously suffered from acetabular bone fractures. We want the forums to be a useful resource for our users but it is important to remember that the forums are
Tina, which procedure did you have? How do you ask your doctor the questions you want to ask? I think seeing several surgeons for different opinions is good judgment. Some patients who have recently had anterior hip replacement may suffer from complications such as wound healing. Specific protocols, therapy and what positions you will be asked to avoid after surgery and for how long will be directed by your surgeon. Uncemented. 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! Two which are receiving the most attention are the traditional posterior approach and the direct anterior approach. Is the hospital where the surgery will be performed also top rated?. Posterior approach. Thanks. These stems are a new design, and therefore do not have an established track record. Additionally, people with certain health conditions such as diabetes or heart disease may also not be good candidates. We are now in a situation where we have found two extremely good surgeons and we gel with both extremely well. Following surgery, the surgeon will devise a routine for the patient to engage in that is both comfortable and safe. The SuperPATH technique is arguably the least invasive hip replacement technique. Hip replacement surgery & recovery time | TRIA Orthopedics - HealthPartners Good question. Traditional Hip Replacement - Traditional surgery requires a large incision of 10 to 12 inches and detachment of muscles from the hip. How long will my hip replacement last in your opinion? I wish you the best of luck with your care. Your out-of-pocket costs for your hipreplacement will be impacted by a number of . We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. After reading your article on disadvantages of anterior approach and also doing extensive online search about this subject, I came to realize that anterior approach was definitely a wrong choice considering my physical build short, muscular, overweight. OTC nerve supplements suggested by a naturopath. It requires surgical insight and skill to accomplish. 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. Woke up with I also regularly receive Rolfing treatments which has helped me manage pain and maintain what mobility I have. The mini-posterior approach involves separating the muscle fibers of the large buttock muscle located at the side and the back of the hip. Brian Tinsley. Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. He is well known as a top doc for 20 yrs & I was persuaded because the mini posterior has less chance of nerve damage & the surgeon has more options for types of spikes, which your article explains well. Studying a hospital and physicians track record before you commit is important. My surgeon wants to use the posterior approach and indicates that I eventually should be able to play golf again. You should avoid sitting in low chairs, beds, or toilets. They also are looking into methods to reduce the risk of infections in artificial joints. Optimal component positioning also is critically important for the best stability and longevity. 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. In the United States, a traditional posterior approach is the most commonly used. No, I would not tolerate the pain and immobility, if there is a reasonable way to relieve it. We can do this because of improved plastics. Really Great. I typically do hip replacement on the get anterior approach in 90% of my patients. Is it really as good as it sounds? Disadvantages of the anterior approach include: The nerve which supplies sensation to the front and side of the thigh is vulnerable. I emphasize continuing exercises at home especially walking. It is normal to want to recover quickly and return to a very active lifestyle without pain. I also think its reasonable to look forward to returning to all of the listed activities that you enjoy. Dr Leone, you make the point several times that the surgeon, not the procedure is most important. Some other methods are effective, but they are less effective for patients who leave the hospital earlier. Hip replacement currently consists of two major approaches: direct anterior and anterior approaches. J Bone Joint Surg Am. I just saw a patient with a femoral neuropraxia after a anterior approach THR. I would rather my patient get half as much anesthesia. [QxMD MEDLINE Link]. Do you have any thoughts on this issue? Surgical Approaches Used for Hip Replacement - Verywell Health Just getting your thoughts I will discuss it more with my surgeon at the pre-op meeting. 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. This too will lower your anxiety and improve your experience. No special surgical equipment is required when performing a mini posterior. . I had posterior and much like the superpath trussed into the jig . Since then, SuperPATH has enjoyed excellent success. Glazener C, Fraser C, Hutchison J, Vale L. Single mini-incision total hip replacement for the management of arthritic disease of the hip: a systematic review and meta-analysis of randomized controlled trials. 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 am sure you should not listen to what I did!! Doc says once recovered I should avoid flexion with adduction and internal rotation. Patient Resources Also, since I am only 51, I am concerned about component longevity. Its Inosine and Sphingolin. Many times, the depth of the destruction that is found during surgery is much more advanced than initially anticipated, particularly as we age. (PATH) and Supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty: learning curves and early outcomes. In severe cases, I will use my patients own femoral head, which is removed as a bone graft to help stabilize the new cup and garden new bone for the future. Finally, in July 2013, the first SuperPATH Hip replacement in Australia was performed in Nepean Private Hospital, Sydney. Ann Transl Med. Other jobs, which tend to be more structured and / or more physical, may require more time off. I have not seen this before because in the past, the complication from hip surgery were sciatic nerve injury from posterior approach. When asking a prospective surgeon about the anterior vs posterior approach he told me that it is necessary to use a smaller prosthesis which would not be as stable with the anterior approach and did not recommend it for this reason. With much respect I look forward to your reply. 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. Others continue to follow traditional guidelines. But after reading your articles, I am hesitant about that choice now. I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. What reasons would there be to use the regular over the mini? I, personally, have not had a patient dislocate following a primary total hip replacement in many years. Some in the early period have good track records, others do not. The main limitation after surgery is a lack of comfort. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. Most patients are able to walk the day of surgery. Also, in the U.S., nearly all stems which are being implanted through the anterior approach are press-fit rather than cemented. I believe a THR will benefit you tremendously. They are encouraged to be very active and most stop using a cane, can drive their cars and are exercising in the pool, just two weeks after surgery. Hip pain, soreness, and stiffness can quickly become unbearable and sideline us from the things we enjoy the most. A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). There is a more than 200% chance of knee infection, most likely because the knee has more surfaces that can become infected with an infection. Posterior, mini posterior or anterior? Should I be though? Comparison of short-term outcomes between direct anterior approach (DAA An anterior hip replacement procedure, on the other hand, performs the same function as an anterior hip replacement in terms of tissue shaving. The surgeon I went to said he does THR using a lateral approach. Apples to apples which procedure has the lowest incident of complications? General comments will be answered in as timely a manner as possible, Hip & Knee Surgery (Of course, I do.) I then stage the second surgery as early as 2 or 3 weeks post-operatively. My physical life is diminished. 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. What has changed the most in my career, once again in a very positive way, is how quickly patients start walking (day of surgery), and go home and return to their active lives after THR, as compared with just a few years ago. The source of your hip pain must be diagnosed. On July 17th, I had a left THR. A miniposterior approach uses the same intervals as the standard posterior approach but simply less tissue is released for the exposure. Posted
Remember, what youre hoping to do is have a hip construct that will last 20 years or more. 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. Introduction. All orthopaedic surgery demands a long recovery period. During the procedure, the patient must have a small incision made in the side of his hip. I would not recommend pushing your surgeon to use one specific approach or another. 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. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. It is nice to see honest Q&A versus a marketing page. 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. I think stem cell injections will have little chance of doing any good if indeed your hip condition has already progressed to bone on bone. Infection. Hip replacement is a fantastic operation that can help relieve pain, improve daily function, and improve quality of life. Many people seek anterior hip replacement due to the unbearable pain they feel in their hip joints. Hip replacement - Doctors & Departments - Mayo Clinic Dr. Tom Miller gives you the five best options for hip replacement surgery. I am still a very active 67 yr old, I like to ski, bike, hike (steep terrain) with about 25 pds. I did have numerous blood tests, MRI of knee and hip, total body scan with radio active injection, X-ray knee and hip etc. Email us. What, if anything, can be done to revive femoral nerve and get my thigh muscles back in normal? SuperPATH hip replacement Pros and Cons - Thoracentesis In bed for long periods with little or no movement. 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.