While new techniques, instruments and prostheses have been developed specifically for minimally invasive surgeries, there are many well-established approaches to hip replacement. After reading your articles, I have decided not to have anterior. 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. 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. Your article lacks the pros of the AMIS and the cons of min invasive posterior. I went with a total hip replacement. Therapy hopefully will help any contractures and scaring within your muscles that might have developed after surgery. I am 63 years old, 54, 115 pounds. It is much better to precisely release and cut rather than tear or fracture. A major hip replacement can take up to four months to fully recover from. SuperPath Tissue Sparing Hip Approach | MicroPort Orthopedics When we quote probability of longevity after hip replacement based on following people who had the operation, it is based on standard length stems. 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. 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. 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. Dear Dr. Leone, In bed for long periods with little or no movement. Thanks again! 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. Most individuals who have had total hip replacement surgery fall into this category and simply resume their lives.. The new prosthetic socket must be medialized (placed further toward the midline) and sometimes through the medial wall of the native socket. I am feeling like this is a business like everything is else. I had a consult with a surgeon who does posterior and cuts muscle & tendons. Losing weight and strengthening your muscles pre-operatively will make surgery easier and greatly facilitate your rehab. Because the patient is lying on his back during the procedure, fluoroscopy or moving x-rays are used to aid in the examination. I deal with major nerve damage on front of thigh, almost whole thigh. I share your concern that with profuse denervation potentials 10 weeks post injury, that the patient may have sustained a more severe injury than a neuropraxia. Have you recovered by now? However, some offer greater patient benefits than others. SuperPath experiences good or bad | Hip Replacement - Patient I have since read that hips with this condition might get worse after labrum repair due to this structural defect. I have seen 2 doctors one doing posterior, the other anterior. Patient does not provide medical advice, diagnosis or treatment. Original Medicare (Part A and Part B) will typically cover hip replacement surgery if it's medically necessary. Any info would be appreciated. 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). Also, is it immoral for an 80 year old to have THR and cost the nations health care system $25 $35k? This robotic technique can assist in producing an excellent result. 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. Total hip replacement is a step-by-step surgery to replace the hip socket and the ball at the top of the thighbone (femur). Did you have the surgery via Superpath method? The surgeon does about 200 a year and people say he has a good reputation. Update what hes cutting is the adductor so my question is the same is this just a normal part of some THRs? Comparison of short-term outcomes between direct anterior approach (DAA The posterior approach, then, is less inherently stable but may or may not require precautions. The most important variable is how quickly the person is motivated to return to work. In a very positive way, surgical techniques for both anterior and posterior approaches have evolved wonderfully since your surgery was done 10 years ago. 2004 Apr. The incision made for the operation can be as small as three inches. Even if the hip doesnt dislocate, prosthetic or soft tissue impingement is not beneficial. Being cared for in a hospital that specializes in joint replacement and has an extensive specialty medical staff also is key. Always speak to your doctor before acting and in cases of emergency seek A modern artificial hip joint is designed to last for at least 15 years. This interval must be developed and the muscles must be separated in order to reconstruct the hip. Sometimes the pain goes away as I walk and sometimes it doesnt. I take care of many individuals who have a total knee and hip replacements on the same side. Intervals between muscles are separated or muscles are separated in line with their fibers without injuring the muscles innervation. Hello Dr. Patient Concerns There is less risk of neurological injury. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. That means you have an excellent track record. disadvantages of superpath hip replacement Otherwise you will be prompted again when opening a new browser window or new a tab. It seems, however, that at this time point, patients who have received resurfacings do as well or better than similar patients who have received total hip replacements. Historically in my practice I performed many Bilateral THR and TKR and have backed away from that practice. Each approach you list has advantages and disadvantages. 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. This technique is also referred to as the . I'm hoping to read some posts post surgery. When discussing the options, my surgeon all of a sudden suggested performing anterior approach. Yes, you can do very well. I think it is important to define and isolate why youre doing so poorly. I tore my labrum at age 43 and only discovered then that I had bilateral dysplasia. Getting in and out of cars, and turning over in bed. 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. Its been 8 months now. Surgical Approaches Used for Hip Replacement - Verywell Health crackling noise/pain, cannot bend them or kneel in church or get on the floor to do exercises, I am very afraid to ending up in a wheelchair or having to use a walker the rest of my life.I am a very active 65 year old, and very, very worried about the hip surgery. Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. What are your thoughts on the use of robotics? Some people may find that traditional hip replacement surgery is the best option for them, while others may prefer a minimally invasive procedure. It is also important to avoid any sudden movements or twisting motions. What are the risks involved? How Much Does Minimally Invasive And Robotic Hip Replacement Surgery If this occurs, the patient may experience pain and swelling. 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 of this, when you're ready to get up and walk about again, engaging your muscles and hip flexors might be extremely tough. After reading your blog Im thankful he suggested this approach. This treatment is commonly recommended for patients suffering from osteoarthritis of the hip. Also on MRI there was a cyst (good size). 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. Mayo Clinic researchers have studied ways to reduce blood loss, control pain and speed recovery for people who undergo hip replacement surgery. SuperPATH or Superior Approach To The Hip In Total Hip Replacement Once youve decided, you then need to trust that he or she will take the best care of you possible to deliver the best results. Over the last six years, I have performed more than 2000 primary or first-time total hip replacements using the mini-posterior approach and I am aware of only one patient who dislocated his hip because he fell down stairs. I went in with high expectations of coming out so much better off and here I am 5 yrs out limping more than ever and a NUMB thigh and worse knee and weak ankle. Inpatient footage of the patient compilation has been edited out to accommodate hospital rules. If youre impressed by how clean it appears and the movement and professionalism of the staff, that obviously is a good sign. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. Hip replacement - Wikipedia (tho I am sure I asked about it ahead of time), I believe you are having trouble finding definitive answers and recommendations because every surgeon has his or her own recipe and experience and also the medical recommendations keep changing. Rush joint replacement surgeons are leaders in hip replacement surgery and research. 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. Nobody wanted to talk Also available today are larger modular heads, made possible because our plastics are so much better than years prior. I assume PTHR is referring to partial hip replacement. The rule of thumb is that recovery occurs over a 12-18 month period following injury. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. Im sorry to hear that you struggled after your first, anterior-approach THR. I advise both my total hip and my total knee patients to avoid repetitive impact activities like distance running. Mar 13, 2013. Choosing a surgeon based on his or her experience and complication rate also is exactly right., My strong advice is to choose your surgeon, not the approach. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. 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 . There is a 1-2% risk of fracture of the femoral neck. I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. Recognize that the underlying etiology is not being corrected by this procedure, so relief of symptoms probably will be temporary and possibly partial. They may have a certain cut-off criteria (for example, a BMI of less than 35). 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. thank you for your time. Thank you. Also, how about hip restructuring instead of Total Hip Replacement. 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. Both approaches have been shown to have potential in research. Its interesting that when we critically analyze all the variables that ultimately make up the experience that one person has compared with another, or that one person experiences on one side versus the other, we come to recognize its not so straightforward. The anterior approach has a lower incidence of sciatic nerve injury and a higher incidence of femoral nerve injury. In 2014 I had to do another THA, this time on my right side. After awhile the screws started shifting and poking up under the skin and they removed them. Posterior hip surgery may be the best option if your surgeon makes a larger incision at the side or back of the hip joint. The most common total hip replacement method is the anterior approach, which allows the surgeon to see better, more precisely place implants, and perform less invasive total hip replacement surgeries. I am scheduled for total hip replacement in about 3 weeks, and none of these procedures/options were discussed with me.the surgeon just said that it was a risky surgery and he could not guarantee anything! I still have a very big limp and still undergoing physical therapy. Before my hip problems, I really enjoyed playing golf and would like like to play again after surgery. Because the dissection is over the front of the hip, a number of patients will experience residual pain and tightness anteriorly (in the front of the hip) at least early on. I would like your opinion. What is most important is choosing your surgeon. The anterior approach, as a marketing tool, has grown in popularity among surgeons. While it is a surgery that does help many, many people, clearly you are struggling. 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. Comments about life-long hip restrictions between Posterior, Anteriorlateral and Anterior approaches? disadvantages of superpath hip replacement - homelessnest.org I do not want the approach to dictate the optimal construct which I hope will last 20 years and more. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at [email protected]. According to the meta-analysis, DAA (depressing the anterior hip joint by using a metal rod) is associated with significantly shorter hospitalizations than lateral approaches, as well as increased functional rehabilitation and lower perceived pain during the first few days after surgery. In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. Also, the surgeon said that I would end up having one leg shorter than the other is this true? When the capsule is fully healed, it forms strong ligaments that will eventually regrow (it will take about 4 months for the capsule to form again). 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. 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. Finally, because my patients are walking the day of surgery, most want to go home rather than to rehab. Further, the extent of dissection is more minimally invasive, which also improves stability. Why I No Longer Use the Anterior Approach for Primary Total Hip Pain and disability are reduced. 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. My second question relates to something you mentioned earlier regarding checking the published track record of the surgical team if I use an HMO, how do I find that information, and how do I know it hasnt been skewed to give more favorable results (lying with statistics)?