When the stem is placed in the femur, it still destroys the same amount of bone for implantation, regardless of which approach is used. 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. What do you consider to be the most important factors in choosing a surgeon? Also on MRI there was a cyst (good size). Complications from infection account for approximately 10% of all cases. I also would encourage you to choose your surgeon first not the procedure, approach or prosthesis. This most often leaves the patient with an area of decreased or uncomfortable sensation or numbness over the anterolateral thigh (top, outside area of the thigh), not the entire thigh. A miniposterior approach uses the same intervals as the standard posterior approach but simply less tissue is released for the exposure. I would then let that person decide with what approach they think they can best accomplish the surgery and deliver the best result. There is a possibility that blood loss may be reduced as there is less unnecessary exposed bone surface left to bleed. An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. Also, the surgeon said that I would end up having one leg shorter than the other is this true? Im considering this mini posterior approach. 3 years ago, 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. Fortunately you live in a part of the world where there are many capable orthopedic surgeons. And, I Do. Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. They thought it would give me about 5 yrs. Procedures The art of surgery should mimic a well rehearsed ballet or symphony. We need 2 cookies to store this setting. 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. Conclusions SuperPATH approach showed better results in decreasing incision length and early pain intensity as well as improvement of short-term functional outcome. It exploits the inter-muscular interval between the tensor fascia lata and the gluteus medius. No special surgical equipment is required when performing a mini posterior. Also, since I am only 51, I am concerned about component longevity. An anterior-approach hip replacement necessitates a small incision in the groin area on the front side of the leg. I absolutely would not insist on minimally invasive surgery and a small incision, especially considering your mom is short, obese and has osteoporosis. What is most important is that the surgery is expertly done, that the tissues are not brutalized, and that the surgeon can see what he or she is doing. My knee and foot and ankle are messed up too since leg ended up at least 3/4 shorter.I wear a shoe lift, but probably needed it sooner than I realized the shorter issue, My knee is pretty stiff and pain when I walk too much, but I deal with it, it bends good, I sleep good, no pain when I do nothing, so Im working all to do NO knee surgery, This hip was ENOUGH to last a lifetime.. Im 76 and use a lot of supplements to save knee and OA in general..I am looking at other protocols for the knee too.not insurance covered, what else is new.if its good, its out of pocket. Patients can also have as little as a 3-inch incision. Thank you, The surgeon makes 2 incisions one bigger than the other on the rear side and separates the muscle and tendon to get to the hip instead of cutting the muscle and tendons to get to the hip. I wish you luck on your journey. 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. I deal with OA lower back mess so know I see most likely how all this has played into the surgery. The source of your hip pain must be diagnosed. Finally, because my patients are walking the day of surgery, most want to go home rather than to rehab. Im now 6 weeks out and doing good. Hi, I still have a very big limp and still undergoing physical therapy. Thanks again! There always are conditions or circumstances that may predispose one to limp or feel as if their legs are not the same length after surgery, but in my experience this is the exception. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. Will meet with doctor soon but when I was finally able to really exercise after surgery I overdid it and developed plantar fasciitis. and Privacy Policy and steps will be taken to remove posts identified Lift your knee rather than your hip at the same time. 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. Hello Dr. 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. The other things that can affect the op is your fitness beforehand, your attitude and your age, although you may have difficulty getting younger!! Doc says once recovered I should avoid flexion with adduction and internal rotation. Mayo Clinic researchers have studied ways to reduce blood loss, control pain and speed recovery for people who undergo hip replacement surgery. A recent article published by the Journal of Bone and Joint Surgery has demonstrated that the direct anterior hip replacement has more blood loss, a higher risk of intraoperative fractures, an overall higher complication rate and no difference in outcomes versus other techniques. A major muscle is not cut during anterior hip replacement surgery, so pain is reduced and major muscles are not cut after the operation. In my experience, almost all patients who have bilateral THRs go to rehabs and not home. My two questions are: 1. Because of the straightforward exposure of the femur, there is less risk of femoral fracture or poor implant positioning. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. 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. When performing anterior anterior reconstruction, these patients frequently have very short stems that are inserted into the bone. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. Again, considering my own practice, I routinely see my patients recover faster and easier after their second hip or knee replacement because they are more confident having had a good first experience. We have to get ok from cardiologist and get ekg, chest xray, etc. Each question is scored from 1-5, with 1 being no problems and 5 being severe problems. A major hip replacement can take up to four months to fully recover from. The most common type of total hip replacement is done in the anterior anterior part of the hip. In the dark to find out about this myself. Does this mean my body may reject the metal of the post or cup? 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. The surgeon does about 200 a year and people say he has a good reputation. Uncemented. Since 1995, there has been an extremely low dislocation rate and an infection rate of zero percent. I would look for a surgeon who is busy, has a strong track record and who practices at a hospital with a stellar reputation and where many joint replacement surgeries are done. Finally, in July 2013, the first SuperPATH Hip replacement in Australia was performed in Nepean Private Hospital, Sydney. Orthop Clin North Am. Fewer narcotic medications are administered, resulting in a better overall recovery. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. Kenneth, You saw me in your office yesterday (I am 48 years old) as I had complications following a THR of right hip anterior approach with revision 4 days later for a slipped acetabular and then last week I had a dislocated hip. My advice is to have a frank discussion with your surgeon and share these concerns. The anterior approach, as a marketing tool, has grown in popularity among surgeons. Just need reassuranceI am stressing he is fine. If your surgeon cant answer your questions about hip replacement or provides unsatisfactory answers, you may need to consult another surgeon. As you can see, there are no restrictions. In hopes that THA would let me live my normal life without arthritis, instead I can barely walk more than 100 yards without having to stop, my gait is crooked causing lower back problems and my personal life is less than perfect. What you can do is keep as good an attitude as possible and keep rehabilitating your leg. 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. The pain is really inconsistent, one min I will be walking fine and the next it catches and is very painful, then it may go away or may not. I emphasize continuing exercises at home especially walking. Many also mate this with a ceramic femoral head. Need to choose, then select doctor based on that decision. I am 63 years old, 54, 115 pounds. If not, what will my restrictions be? In the United States, a traditional posterior approach is the most commonly used. Do you have any advice or ballroom dancer THR stories to share? I had the posterior approach, the surgeon did not cut any muscle plus I had no pain at all after the op. I had good results into 5th month post op and then everything went downhill. SuperPATH showed better results in decreasing operation time, incision length, intraoperative blood loss, and early pain intensity. It can lead to numbness in the thigh and, in rare cases, skin irritation due to the nerves presence. Hip replacements might keep you out of action for a considerable period. Talked to my foot doc and we decided on the Topaz procedure which has good results. I wish you a full recovery. Although, personally I would feel strongly about reconstructing the hip through the mini posterior approach (there tends to be considerably less bleeding with this approach), other very caring and competent surgeons might feel just as strongly about using a different approach. Patient Resources In Dr. Lawrence Dorrs opinion, doctors and hospitals should not market a specific type of surgery as the most effective. Blood-thinning medications can reduce this risk. The mini-posterior approach involves separating the muscle fibers of the large buttock muscle located at the side and the back of the hip. 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 am just under 5 ft and weigh 185. I have a tilted sacrum, sway back and a very large posterior. I dont want a long recovery time as I am very active. Once the surrounding tissues fully heal, they then act as a mechanical block to the ball to keep it from being able to jump out.. Anterior hip replacement has the potential to cause complications and pose some risks. I feel good now and walking good now but feel so disabled as I dont know if my hip will dislocate again.I am sorry if you may have responded to some of these questions already as it is so much information to absorb and I dont want to make a wrong decision again. Thank you for this! Everyone I know that has had both posterior and anterior surgery say not to even consider posterior. I have seen 4 surgeons. Had arthroscopy in Jan 15, cleaned up tear and arthritis. Occasionally this even requires making a second, separate incision. Thanks for any feedback. I am unsure whether the minimal invasive posterior is available in SA. Finally, many people who are struggling with hip disease experience lower back pain or even sciatic discomfort. Because the patient is lying on his back during the procedure, fluoroscopy or moving x-rays are used to aid in the examination. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. I spoke in person to probably 4-5 of his success patients and went with hearing from them. Patients can also have as little as a 3-inch incision. I would also like to know about the customized implant, as I havent yet heard much about it. . 35 (2):153-62. No i just had the posterior method which has a larger incision. All: Ive done PT and plan to continue working on strengthening my core and flexibility of those large muscles. I try not to let it get to me, but it causing me to feel handicapped. Often, as the labrum is torn, it leads to a lifting off of hyaline articular cartilage where these two tissues meet, called delamination. Does my prothesis not last as long since I am now doing a 3rd surgery? I have read your articles about procedures (anterior vs posterior). Im hoping to play tennis, go dancing and horseback riding once Ive healed. Length of hospital stay with SuperPath hip replacement approach. My strategy is to make as small an incision as possible, but one that allows for excellent exposure and reconstruction without brutalizing the tissues. Ill be 60 at the time and Im 54 and weight about 130 lbs in fairly good shape. I am a sixty five year old active male and need THR on my right hip. I definitely didnt have any tendons or muscle cut and was cycling on the road from day 12 and back running at week 4 . 1. My recommendation is to go back to your surgeon and share your concerns and issues to see if a fresh and thorough reevaluation wont help define the problem(s) and solutions. An anterior hip replacement is, in many ways, less risky than any other type of hip replacement. 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? There is less blood loss with a single THR than a bilateral, hence less risk of needing a transfusion. What is most important is that you find a surgeon who understands the particular complexities with your problem and whom you trust. Dr. William Leone. The SUPERPATH technique is a tissue-sparing procedure. A hip replacement is the most common cause of complication in about 20% of cases. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. Have you heard of something like this, and if so, is it worth it? Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. Almost all bilateral THR or TKR patients go to a rehabilitation facility after their acute stay, not home. In my experience, after four to six months most patients simply return to normal activity. I suggest you discuss your concerns with your surgeon. In a posterior hip replacement, the procedure is done on the side of the hip. The pain I get is in the groin and a sharp pain in the buttocks, that feels like muscle pain. Im ready to have the surgery, having been basically bone on bone for several years. Risks of SUPERPATH hip replacement surgery Risks due to the surgery may include (but are not limited to): Pain Bleeding Infection Permanent or temporary nerve damage Extra bone or tissue damage Drop in blood pressure during the procedure Leg deformity Blood clot or clots (that could travel to heart or lungs) Delayed wound healing Rather, they say Bill, please just do what you have to do and do a great job. Clearly, he or she has earned your respect and confidence. My advice would be to avoid the extremes of any motion that exceed your hips ROM. That being said, I agree completely with your surgeons advice to have a total hip replacement and not a hip resurfacing. I would avoid the metal-on-metal articulation. 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. Click to enable/disable _gat_* - Google Analytics Cookie. Thank you for this information. Regarding restrictions after your hip replacement, this too is an area that has changed drastically over my 25 year career. 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. The vast majority of my patients have their surgeries with a simple spinal with IV sedation so they are sleeping throughout the procedure . 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. Others continue to follow traditional guidelines. A hospital outpatient surgery can cost between one-third and one-half the cost of an outpatient surgery atCOSC. If this occurs, the patient usually requires a total hip replacement. Have you ever performed the Mini on a patient 1 year after major open heart surgery? I am a 70 yr old female with a 4grade thickness loss at acetabulum and head of femur. Pam. I, too, am struggling which approach to have. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. After reading your article I am concerned about the issues you discussed. All have advantages and disadvantages. Ultimately, it is important to discuss all of the available options with your doctor to determine which method of hip replacement is best for you. Surgical Techniques I'm so encouraged to hear your successful story. Egton Medical Information Systems Limited. Since a significant amount labrum has been removed, I think another attempt at arthroscopy would prove very disappointing and I would not recommend it. Also, after an accident, I had 12 screw and an L shaped plate in my heel. This left hip remained tender based on my exercise level which I did modify but always my hip had some soreness. This can be dangerous because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. I plan to retire from working full time June 2017 and am concerned about having appropriate insurance after that. Once it exceeds this ROM, impingement occurs. General comments will be answered in as timely a manner as possible. This can cause you persistent pain, stiffness . 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.

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