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Robert H. Sigmund, MD | Signature Orthopedics It is highly recommended that you avoid bending your hips and turning your feet together as part of hip precautions. I would rather see my patients go home. 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. Once it exceeds this ROM, impingement occurs. 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. Most receive a simple spinal with sedation. Once again, it sounds as if you had a wonderful surgeon, which is the most important variable. 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. Long recovery but all is well. That said, in general people who are longer, more flexible and thin are more easily constructed anteriorly than individuals who are very stiff, contracted, thick, and have acetubular protrusion (a condition when the femoral head wears away the central cartilage and bone of the acetabulum). I am a 67 year old woman who has danced semi-professionally and has always been very active including doing Ashtanga yoga and caopeira. Overall, it sounds as if youve had an excellent result and wonderful recovery following your hip replacement. Although Superpath hip replacement is often a safe treatment, it may be associated with certain concerns, such as increased postoperative pain, as with any surgical procedure. I had the posterior approach, the surgeon did not cut any muscle plus I had no pain at all after the op. J Orthop Surg Res. So my question is in relation to my body structure. Also, in the U.S., nearly all stems which are being implanted through the anterior approach are press-fit rather than cemented. When compared to the anterior approach to hip replacement, which is typically more painful, there are several advantages to recovering from an anterior approach, including the fact that you will not be required to follow any specific anterior hip replacement precautions, such as bending or crossing your leg. 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. A THR is in my future. I dont think one surgical approach is better or worse than the other for you to accomplish this. There are hybrids of the surgey from what I can see. Blood clots or bleeding. The particular surgeon who did your hip is also uniquely qualified to advise you with regard to the postoperative stability of your particular hip, because he or she physically tested your hip intra-operatively. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. Thank you, Lisa. What you can do is keep as good an attitude as possible and keep rehabilitating your leg. It is important that the individual who ultimately implants your next THR uses the approach which he or she feels comfortable with and has the best chance to deliver the optimal result. 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. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. The healing and maturation of this tissue takes time. Total hip replacement is a step-by-step surgery to replace the hip socket and the ball at the top of the thighbone (femur). Select a surgeon based on your impression of that individual: how engaged was he or she in your care, will you have access to that person as well as his or her team before and after surgery? What is SuperPath hip replacement? I have a tilted sacrum, sway back and a very large posterior. Brian Tinsley. 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. Behavior. We thank you for your readership. When it comes to hip replacement surgery, the surgeons skill, the patients weight and build, and the surgeons level of experience all have an impact. If a revision were necessary, even more bone must be destroyed to remove it. Im sorry to learn that you are so disappointed with your hip replacement. Start your day off right, with a Dayspring Coffee Hip Replacement Surgery & Recovery | University of Utah Health It is important that you find a doctor who is experienced in caring for people with complex issues. I also would encourage pool walking or swimming. This approach has a number of potential advantages, including a shorter hospital stay, less pain, and a quicker recovery. 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 . I then stage the second surgery as early as 2 or 3 weeks post-operatively. 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. If these values are elevated, further investigation with hip aspiration should be considered. Comparison of short-term outcomes between SuperPATH approach and Hip Resurfacing vs Hip Replacement: Know The Difference Your back does need to be evaluated as well. All rights reserved. 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. Your article lacks the pros of the AMIS and the cons of min invasive posterior. Some patients report that symptoms increase in the not-yet reconstructed hip because of the leg length inequality. Hey, thanks for the forum topic.Thanks Again. More soft tissue trauma can result do to this increased difficulty in exposure and then gaining more exposure if necessary. Because the gluteus medius and minimus lie over the anterior capsule and insert into the greater trochanter, it does require greater trochanter osteotomy or more commonly a partial elevation of these muscles from their insertion, which can lead to damage. Help. When done well, your body does well with this technology. Every . A shorter hospital stay and faster recovery are typical of this because there is less damage to the muscles. Posterior or Anterior? For the prevention, diagnosis, and treatment of hip pain and other problems affecting your hips, call Advanced Sports Medicine Center today at (941) 957-1500. 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. It is critical that the patient and the doctor consider whether the patient is a good candidate for surgery, the cost and recovery time, and the surgeons expertise. Are my findings that posterior approach in my situation would have been more appropriate? I think its reasonable to request a tour of the facility where youre considering having the procedure. There are a few disadvantages of anterior hip replacement that patients should be aware of before undergoing the surgery. I would like to share my experience with both procedures. Here is his perspective based on careful observation of outcomes. A long surgery time, on the other hand, was also associated with DAA. Comments about life-long hip restrictions between Posterior, Anteriorlateral and Anterior approaches? 10 users are following. I do participate in competitions and showcase presentations. Years!! Three Cons of Hip Replacement Although total hip replacement is deemed a very safe procedure, there are associated risks that patients need to be made aware of before surgery. SuperPath hip approach. In the front of the hip, fewer muscles are present, so the surgeon works between them instead of cutting through them and then detaching them (and then repairing them after the surgery). In comparison to traditional methods, anterior approaches to the hip joint are more effective. Potentially there also is less pain and a quicker recovery. Pain modifying drugs as well and as a course of NSAIDs might also be appropriate. Hip replacement surgery is less painful than arthritis or fracture-related pain. External rotation of your feet should be limited (avoiding them twisting to the outside as Charlie Chaplin does) and hip hyperextension should be avoided. I prefer spinal anesthesia when possible because fewer drugs are used and often the experience is gentler. Because these cookies are strictly necessary to deliver the website, refusing them will have impact how our site functions. A less stringent set of precautions is required with the anterior approach. Hip Resurfacing vs Total Hip Replacement - sosbones.com Ten years ago I had total hip replacement on the left at hss. There is also a small risk of death associated with any surgery. A miniposterior approach uses the same intervals as the standard posterior approach but simply less tissue is released for the exposure. 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. But I feel that time could be lost and all my symptoms may become irreversible. Infection. Consuming excessive-fibre and wholegrain meals will assist to keep you feeling full, and will be 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. I had the surgery on June 22 and I am about 5 weeks post op. The first is that it is a major surgery, so there is a risk of complications such as infection. My surgeon mentioned also cutting something to free me up at the same time he will be doing the posterior approach surgery. The hip replacement needs to correct the abnormal hip mechanics that lead to the arthritis. Also if the mini posterior approach is so effective when would it not be preferred over the regular posterior approach? Honestly, most 59-year-old active women do best with a well done THR. 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! Tossed the cane at three weeks and went back to work. Depending on the stability and range of motion observed at time of surgery, some doctors dont advise their patients to avoid any positions. OTC nerve supplements suggested by a naturopath. Evidence review for hip replacement approach - NCBI Bookshelf Simply, we keep trying to get better. Surgical Approaches in Total Hip Replacement Problem is that we have seen two doctors and both seem great but are on two extreme sides of the fence. There are risks and recovery times associated with surgery. Because the patient is lying on his back, it facilitates using a fluoroscope or moving x-ray throughout the procedure. I would rather this not happen with my right leg when I have the THR in Jan 2017. The bigger the ball, the bigger the ROM without impingement and the bigger the jumping distance that would be required for the hip to dislocate. If an MRI demonstrates no cartilage damage or subchondral cystification (the development of degenerative cysts), a repairable labral tear and minimal dysplasia, then a hip arthroscopy may be considered. Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. from publication: Current and . No one tells me the same thing? A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. Hip replacement - Mayo Clinic Being discharged to a rehab unit is now the exception. Both approaches have been shown to have potential in research. 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. When a dysplasic hip is reconstructed to THR, its important the abnormal mechanics are corrected, typically by medializing (closer to the midpoint of the body or bladder) the cup. Do I have a risk of fractures during a posterior right hip revision due to my prior complications already? Your symptoms still sound mechanical, positional and episodic. The vast majority of my patients have their surgeries with a simple spinal with IV sedation so they are sleeping throughout the procedure . Hip replacement surgery can open up a world of possibilities for people who have lived with pain and restricted movement. After the direct anterior approach, there is generally no hip precautions required, and motion is not restricted. A modern artificial hip joint is designed to last for at least 15 years. The second advantage of a small incision is that it makes it easier to clean and care for the hip. appropriate medical assistance immediately. 4. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. Click to enable/disable essential site cookies. SuperPATH hip replacement Pros and Cons - Thoracentesis And does A really have none. 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, I would choose a doctor with whom you connect and whose staff is engaged and knowledgeable. Dr. Himmelwright Introduces SuperPath to OIP (Of course, I do.) My advice is to have a frank discussion with your surgeon and share these concerns. SuperPath Tissue Sparing Hip Approach | MicroPort Orthopedics There has been an increase in the range of motion. My doc said the angle of my hips is not the worst but also not the best. When discussing the options, my surgeon all of a sudden suggested performing anterior approach. Mar 13, 2013. The leg lifts really aggravate the front of the hip. Infection. 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). I advise both my total hip and my total knee patients to avoid repetitive impact activities like distance running. Every hip implant has benefits and risks. I suggest you discuss your concerns with your surgeon. I was thinking of doing that 1st, maybe April(Ill be in boot 4 weeks), and then the PTHR in either Sept or next Jan when I have free time. Also, when a single joint is replaced versus bilateral, there is significantly less bleeding and hence a much decreased need for transfusion. 2. Patient Concerns She provided all kinds of benefits with this approach, as faster recovery, less motion restrictions et.al. A number of patients who have undergone this procedure are able to walk unassisted the day after surgery . Hi, The most important decision you must make is choosing your surgeon. Very important with both the traditional posterior and the mini-posterior approaches, if the surgeon is not able to visualize critical structure adequately, or if a problem were to arise such as a fracture, then either approach can easily be adjusted. I am about to have a hip replacement and would like to know what kind of limitations Ill have afterward. After reading your articles, I have decided not to have anterior. SuperPath Hip Replacement - Elvis Grandic, MD It typically requires a 4 to 5 day hospital stay, 3 to 6 month recovery period . Had a total hip replacement aug 2013. Does this mean my body may reject the metal of the post or cup? Its also reasonable to ask to speak to other patients who have undergone THR using this technique to learn about their experiences and results. Nerve regeneration can occur up to 18 months following injury, but the chance of full recovery decreases with delay in recovery time. The impingement can lead to a levering out of the ball from the socket. You should feel good that you are aware of your fears and that it hasnt paralyzed you into not acting. Patients can also have as little as a 3-inch incision. http://holycrossleonecenter.com/blog/hip-resurfacing-or-total-hip-replacement-a-candid-discussion/, http://holycrossleonecenter.com/blog/metal-on-metal-hip-replacements/, I wish you the very best recovery. I should think that all your expectations are appropriate for the activities you look forward to, especially considering youve already done so well after your knee replacement. The mini posterior approach works wonderfully and predictably when expertly performed. for Orthopedic Care I was out of bed walking around the evening of the surgery . SuperPath Hip Replacement (Surgery) : 3D Animation - YouTube Overall, however, anterior hip replacement is a safe and effective procedure with a high success rate. I would discuss fully your goals and concerns. In bed for long periods with little or no movement. If you have an abnormal anatomy or are morbidly obese, you may not be a good candidate. Dont let PR marketing confuse the big picture. Nobody wanted to talk Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis.Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. SuperPath hip replacement is a newer method and has been used since 2019 at Leicester's Hospitals. The femoral prosthesis is inserted into the hollow part of the femoral shaft. We can do this because of improved plastics. I think researching the hospital where you will have your surgery is very important. I am a 70 yr old female with a 4grade thickness loss at acetabulum and head of femur. Many times, the depth of the destruction that is found during surgery is much more advanced than initially anticipated, particularly as we age. Thanks again! I have been in excruiting pain and unable to do everyday normal activities. Of note, I am a RN with 30 years of experience and took this decision very seriously. Also there are concerns about disruption of blood supply to femoral head with this operation. It requires surgical insight and skill to accomplish. Most of the restrictions are removed at that time, although I still advise common sense, particularly for the first three or four months. 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. In 2014 I had to do another THA, this time on my right side. I recently had a spontaneous hip fx and was diagnosed with hip displasia. Since 1995, there has been an extremely low dislocation rate and an infection rate of zero percent. Not sure exactly what that means. Pros and Cons of Hip Replacement Surgery | IBJI The art of surgery should mimic a well rehearsed ballet or symphony. Very strange I think the recovery time is the same though. It is important that the individual who ultimately implants your next THR uses the approach which he or she feels comfortable with and has the best chance to deliver the optimal result. 1.2. I try not to let it get to me, but it causing me to feel handicapped. Again, trust your doctor. One disadvantage to the mini posterior approach is that patients are instructed not to place the newly implanted leg in certain positions for the first six weeks after surgery. These other conditions need to be defined and hopefully ruled out as the primary source of pain. 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. This allows you to resume normal daily activities quickly while also returning to normal range of motion and function. Thank you for this great informative discussion. Along these same lines, there is a smaller incidence of sciatic nerve injury with the anterior approach but an increased incidence of femoral nerve injury. The SUPERPATHTM procedure provides a number of advantages over traditional hip replacement surgery. Also, patients with shorter femur necks and genu varus (lower angle between the shaft of the femur and the femoral neck) are more difficult anteriorly. My problem isnt from a worn-down joint with no cartilage. Hip Replacement Surgery Technique Pros & Cons | Portsmouth Personally I had the posterior approach and cannot see how I could have recovered any faster . I seem to be able to hike just fine up hill and down but not always on the flat. SuperPATH showed better results in decreasing operation time, incision length, intraoperative blood loss, and early pain intensity. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. I, personally, have not had a patient dislocate following a primary total hip replacement in many years. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. If this occurs, the patient may experience pain and swelling. I still have a very big limp and still undergoing physical therapy. 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.. Dr. William Leone, Hello Dr. 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? Conclusions SuperPATH approach showed better results in decreasing incision length and early pain intensity as well as improvement of short-term functional outcome. I assume PTHR is referring to partial hip replacement. The best of luck to you, Hip anatomy 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.