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Until now. All: Does it really not matter which approach I have, posterior or anterior? An anterior-approach hip replacement necessitates a small incision in the groin area on the front side of the leg. What are the experiences of other countries with THR? Thank you for sharing. The anterior approach, as opposed to the lateral or posterior approach, uses a small incision in the front of the hip. Hip Resurfacing vs Total Hip Replacement - sosbones.com 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. Minimally Invasive Hip Replacement Procedure | Arthritis-health I am a 73 year old woman who has been having severe hip pain for the last seven months. Yes, Im angry. As a result of the interventions, the surgeon has a better view of the hip joint. Everything does point to posterior being the better of the two, but first i wasnt given a choice, and much easier said to shop for surgeon, than to do it, when only one in this area takes my insurance. For example, the stability of the components could have been achieved initially, but then proved inadequate so you developed either a loose cup and/or a loose stem. Getting those studies will not change the reality that you will need THRs. With mild dysplasia, positioning and implanting the new cup usually is not more difficult than with other conditions. Because of the marked improvement in modern plastics, there is greater longevity and durability of acetabular plastic liners and larger femoral heads are used routinely which results in an improved the head/neck ratio and therefore the jumping distance for a hip to dislocate. 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. SuperPATH Total Hip Replacement Phoenix, AZ | Total Hip Replacement Arizona 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. His hip ball was put back in the socket and he has done beautifully since. Therapy hopefully will help any contractures and scaring within your muscles that might have developed after surgery. There are many different quality implants (just like surgeons and hospitals). He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. Im not sure why you developed a problem with your IT band. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. 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. Surgical approach is important but its just one of many important variables. Unfortunately, injury to the lateral femoral cutaneous nerve is a common complication after the anterior approach for hip replacement. appropriate medical assistance immediately. Some surgeons will use 2 incisions, both the anterior and superior approach. Rather, they say Bill, please just do what you have to do and do a great job. Femor fracture. 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. Use of the forums is subject to our Terms of Use Regarding restrictions after your hip replacement, this too is an area that has changed drastically over my 25 year career. Also, when a single joint is replaced versus bilateral, there is significantly less bleeding and hence a much decreased need for transfusion. Most patients after a bilateral procedure would not go home but rather a rehab unit. In general, if someone is dedicated to the job, the return is very quick. Changes will take effect once you reload the page. I typically do hip replacement on the get anterior approach in 90% of my patients. I would recommend having an honest discussion with the surgeons you are considering. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. Need to choose, then select doctor based on that decision. I don't think there's a one size fits all when it comes to hip surgery. Regardless, the overall incidence of dislocation for every approach is smaller due to use of larger femoral heads and enhanced closure techniques. I saw a surgeon who does the posterior approach only and will see another on 4/14/15 who does both approaches. This can be dangerous because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. I know the most important decision you will make is choosing the doctor who will perform your surgery. However, there are also some potential drawbacks to this type of surgery including a longer surgery time, a greater risk of blood loss, and a higher risk of nerve injury. 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. He strongly recommends the anterior approach as the only way to go. The surgery time is much less with a single joint and therefore the sterile surgical instruments are opened and exposed to the environment for a shorter time. I am a very active and young 69 year old female who had a THR on my left side 5 years ago. Download scientific diagram | (a) Components of a total hip replacement; (b) The components merged into an implant; (c) The implant as it fits into the hip [15]. Most activities of daily living have an element of hip flexion (knee up to head), which is a safe position after the anterior total hip. It turned out to be more torn than they thought and they had to cut about a forth of it out. 3. Iliotibial (IT band) damage, had 2 months of ART release work on this issue. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. Hey, thanks for the forum topic.Thanks Again. Often, as the labrum is torn, it leads to a lifting off of hyaline articular cartilage where these two tissues meet, called delamination. I was initially sent to a surgeon to consider repair but he said my chances of being happy with the outcome were only 30% and suggest a THR. But this blog was a nice nudge toward the posterior. Currently we use standard ways, called either posterior or direct lateral approach. Thanks. I weigh 185 and am 54 and realize its ideal to lose weight prior to surgery (working on it as always). Are my findings that posterior approach in my situation would have been more appropriate? I, too, am struggling which approach to have. The majority of teaching institutions in the United States continue to instruct as well as perform the traditional posterior as their primary approach. During the procedure, the patient must have a small incision made in the side of his hip. I have the surgery planned, but then another medical professional warned me that the posterior approach will limit my twisting range of motion and prevent me from playing golf. They thought surgery to repair it would give me about 5 yrs. Some other methods are effective, but they are less effective for patients who leave the hospital earlier. Hip replacement surgery is less painful than arthritis or fracture-related pain. I try not to bring up my mess but its hard when its with one 24/7. And, I Do. 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. I wish you the best of luck, If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. Both have valid cons against the others methods and pros on their method. Honestly, most 59-year-old active women do best with a well done THR. Length of hospital stay with SuperPath hip replacement approach. Can you compare/contrast to the other approaches; posterior, mini posterior, anterior? I am very athletic and active even with many years of pain from bone on bone arthritis so I am worried about restrictions since Ill probably forget or something. As of 2020 only Dr. Leone is using the latest hip technique called the SPAIREtechnique where patients no longer have hip precautions after surgery. A mini posterior approach is a modification of the classical posterior approach. Its also reasonable to ask to speak to other patients who have undergone THR using this technique to learn about their experiences and results. If your surgeon did a great job, that is something to respect. Click to enable/disable essential site cookies. Over time, some patients may acquire sensitivity or an allergy to the metal particles produced by the metal ball and socket. The nerve which supplies sensation to the front and side of the thigh is vulnerable. Advanced Ortho Surgeons | SuperPath Hip Replacement This can cause you persistent pain, stiffness . I often suggest to my patients that they speak to other patients for whom Ive cared and to whom they can relate to learn about their experiences. It is critical to make the right decision regarding anterior hip replacement surgery in each case. An anterior approach to hip replacement allows the surgeon to perform more limited views of the hip joint during the surgery, making the procedure technically challenging for less experienced surgeons. Dr. Leone, I am coming in to see you for an appointment for a THR to my left hip. Overall, however, anterior hip replacement is a safe and effective procedure with a high success rate. Our insurance covers both. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. Fortunately you live in a part of the world where there are many capable orthopedic surgeons. I have congenital hip dysplasia which has gradually caused more pain as Ive gotten older. He is highly respected by the medical and chiropractic community, so i plan to have a appointment to discuss his plans for my surgery. There are many effective approaches and techniques that allow implantation of a total hip. What reasons would there be to use the regular over the mini? I had the mini posterior approach done and it gets better everyday. I very rarely transfuse any patients now. In a posterior hip replacement, the procedure is done on the side of the hip. (Of course, I do.) Better luck to you all. The big difference in anterior vs posterior hip replacement is primarily where the incision is made and how long it is. 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. No one tells me the same thing? Im sorry to hear that you struggled after your first, anterior-approach THR. Hip implants are medical devices intended to restore mobility and relieve pain usually associated with arthritis and other hip diseases or injuries. It exploits the inter-muscular interval between the tensor fascia lata and the gluteus medius. I had to cut some strength exercises out leg lifts, hip sled. 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). Hi, In some individuals, it takes much more force and dissection in order to accomplish this (typically, there is significantly more bleeding from an anterior approach compared to a mini-posterior approach). The anterolateral approach or Watson Jones approach is one of the classical hip approaches that can produce excellent results when utilized for THR. Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. To have your other hip replaced through a different approach is a decision you need to make with your surgeon. In the dark to find out about this myself. The SUPERPATH hip replacement is a new technique using superior capsulotomy that allows for implantation of the total hip components under direct vision through a single incision. I believe a THR will benefit you tremendously. The posterior approach is used by a small percentage of people. These parts have a porous coating that the bone grows into. Choose your surgeon. Achieving legs that feel equal in length after surgery is imperative. Here is his perspective based on careful observation of outcomes. [QxMD MEDLINE Link]. Also, in the U.S., nearly all stems which are being implanted through the anterior approach are press-fit rather than cemented. Dr. William Leone. In the hands of a master, all can produce wonderful and predictable results. 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. That I knew this recovery may take 1-2 William Leone. Had a total hip replacement aug 2013. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures.A total hip replacement (total hip arthroplasty or THA . Thanks so much for this information! hi im following as im due a superpath soon, there is no one size fits all everyones different I've had 2 hip replacements in 2 yrs one in 2017 then a revision to change the ball and socket to the smallest one they had and now I'm going for a smaller stem I had the anterior approch done which is in the front which is way better then the posterior as the front they can just move ur muscles over to the side to accsess ur hip rather then go through the back or side where they have to cut the muscles. The traditional posterior approach is the most commonly used in the United States and throughout the world (about 70 percent). The last page is asking the participant to self score their health that day out of 100. 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. Your article has made it clear I made the correct decision, especially since my daughter had nerve damage from an operation years ago. It also helps to stabilize the acetabular shell and prevent soft tissue irritation on the out edge of the cup. It is normal to want to recover quickly and return to a very active lifestyle without pain. I spoke in person to probably 4-5 of his success patients and went with hearing from them. We thank you for your readership. Report / Delete Reply kelly1010 nicole66881 4. 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. Patients can also have as little as a 3-inch incision. According to Dr. Gililand, patients should not try to change their surgeons opinion based on their preferences. THR - Posterior or Superpath Decision - Joint Replacement Patient Forum SuperPath Hip Replacement Baton Rouge | SuperPath Surgeons Baton Rouge The hip joint needs to be replaced again when it no longer works properly because of a revision surgery. The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. I dont know what happens on that tablewas he in a hurry on Friday afternoon. 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. In my experience the approach used to replace a hip does not effect how quickly a patient recovers. The second advantage of a small incision is that it makes it easier to clean and care for the hip. From what Ive seen, most THR patients dont need very much PT, although I do encourage exercising in a pool. The physical build of some patients increases the difficulty. Just because hardware in your foot needed to be removed after repairing what sounds like a calcaneal (heel) fracture, absolutely does not mean that your body rejected the metal / hardware or that your body will reject the prosthesis your surgeon will implant to reconstruct your hip. The pain I get is in the groin and a sharp pain in the buttocks, that feels like muscle pain. In my experience, almost all patients who have bilateral THRs go to rehabs and not home. SuperPATH showed better results in decreasing operation time, incision length, intraoperative blood loss, and early pain intensity. Will I still be able to do the things I like to do? I did have numerous blood tests, MRI of knee and hip, total body scan with radio active injection, X-ray knee and hip etc. If a mini posterior approach is used and the resultant total hip has optimally positioned components and balanced soft tissues, and was implanted through a smaller incision with less underlying soft tissue dissection and trauma, then I believe it is a benefit. I have cared for many patients over the years with significant heart and peripheral vascular disease. The SuperPATH technique is arguably the least invasive hip replacement technique. 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. Mar 13, 2013. 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. Pam. By 2016 and over 300 SuperPATH cases, the results of very first 100 SuperPATH surgeries (the so called 'learning Curve') were published in a peer reviewed journal with . 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. I encourage you to do the same. 2. Start your day off right, with a Dayspring Coffee 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'm scheduled for THR on the 22nd. The second most-common injury is to the femoral nerve. These scores are not aggregated. A hospital outpatient surgery can cost between one-third and one-half the cost of an outpatient surgery atCOSC. 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. What to Expect I had a consult with a surgeon who does posterior and cuts muscle & tendons. 1. It would be interesting to hear what you have to say Doug. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. A hip replacement is the most common cause of complication in about 20% of cases. I just saw a patient with a femoral neuropraxia after a anterior approach THR. SuperPath experiences good or bad | Hip Replacement - Patient Some hospitals and surgery centers are promoting one method of hip replacement over another. Other combinations of materials have advantages and disadvantages (for instance, some researchers believe that ceramic-on-ceramic types may be more durable, but they have also been known to make squeaking and popping sounds.) The highly crossed linked polyethylene liners are now the gold standard in this country. My question is: should I just tolerate the pain and limp, or take a chance with the hip replacement. Posted More soft tissue trauma can result do to this increased difficulty in exposure and then gaining more exposure if necessary. In my experience, usually releasing the ileopsoas tendon insertion onto to lessor trochanter and medial hip joint capsule, and then manually stretching the leg into an abducted position after THR reconstruction, obviates the need for formal release. As you can see, there are no restrictions. Even if the hip doesnt dislocate, prosthetic or soft tissue impingement is not beneficial. 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. I recently had a spontaneous hip fx and was diagnosed with hip displasia. surgeons certainly do not go out of their way to cut anything, they move stuff about, if tendons do get damaged, it's more likely from the anterior approach as they have less 'sight' of the procedure due to the smaller incision. Is THR something that can help? Typically, most are eager to go home the very next day; many have already progressed to a cane, which they will not use very long. Others will be empowered when they read and relate to you and/or your experience. Have you heard of something like this, and if so, is it worth it? Because the mini-posterior is more straightforward, many surgeons think it provides an increased margin of safety for the patient, because the incision can easily be extended if exposure is poor, or if a fracture occurs. Share your concerns with your surgeon. How the soft tissues are handled and respected, the patients expectations before the surgery and the surgeons experience do. Granted I do deal with lower back OA and right knee OA and now all worse and now foot/ankle mess, all on right hip side. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. I will reiterate what I know to be true. No i just had the posterior method which has a larger incision. Can I make an appointment with you. Also if the mini posterior approach is so effective when would it not be preferred over the regular posterior approach?