Disadvantages of the anterior approach include: The nerve which supplies sensation to the front and side of the thigh is vulnerable. Patients understand the risks that metal joints and sockets bring to their long-term health and are moving away from the material. SuperPath hip approach. What do you consider to be the most important factors in choosing a surgeon? My doctor does not do mini posterior, therefor I have a 6 incision. Hello Dr. 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. Robert H. Sigmund, MD | Signature Orthopedics 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.. Will I be able to dance, hike, bike, swim, exercise after a 3rd surgery? There are several positions to avoid after anterior hip replacement, as they can put unnecessary stress on the new hip joint and lead to dislocation. The approach planned is a frequent topic of Continued External rotation of your feet should be limited (avoiding them twisting to the outside as Charlie Chaplin does) and hip hyperextension should be avoided. In 2013 I had a THA done on the left hip. I would research and find the physician and hospital that will give you the best chance of doing well. The surgeon I saw said that my body structure and gait does not affect which approach would be ideal for my body. Le has extensive experience in primary joint replacements, complex revision surgery, periprosthetic fractures, and infection management. I would like your opinion. SuperPATH is a micro-invasive method of performing a standard total hip replacement where the surgeon utilizes a smaller initial incision and, more importantly, a very limited dissection in the deep tissues. For risks she mentioned all the usual I knew about from the first surgery blood clots/loss, dislocation, etc. That's all I know. SuperPath approach uses about a 3-inch incision at the side of . 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 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, many people who are struggling with hip disease experience lower back pain or even sciatic discomfort. Glad that after lots of PT and massage and medial branch block for back issues with NO!!! I would stay away from narcotics. 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. Testimonials Hips that are out of joint have an anterior hip replacement. During the procedure, the patient must have a small incision made in the side of his hip. An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. We thank you for your readership. Surgical Approach Types | Hip Replacement | Elvis Grandic, MD I walk a lot in my job and bend lots (work with children) and sitting causes pain due to impingement. #1. My question is: should I just tolerate the pain and limp, or take a chance with the hip replacement. 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. I think it perfectly ok to discuss different approaches and ask for an opinion. It is also important to avoid any sudden movements or twisting motions. These stems are a new design, and therefore do not have an established track record. 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. The first is that it is a major surgery, so there is a risk of complications such as infection. Hospitsl staff Im ready to have the surgery, having been basically bone on bone for several years. Total hip replacement is one of the most successful operations ever developed and is a remarkably predictable way to relieve pain from arthritic conditions. 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. Blood clots or bleeding. Also, when a single joint is replaced versus bilateral, there is significantly less bleeding and hence a much decreased need for transfusion. What to Expect It helps the surgeon implant the acetabular component in a very precise position. The following cookies are also needed - You can choose if you want to allow them: You can read about our cookies and privacy settings in detail on our Privacy Policy Page. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. If was 3 weeks after discharge Mine certainly have. If I can put you on the spot. We need 2 cookies to store this setting. Often in this group of patients, their X-rays show only minimal cartilage space compromise (it may appear thinned and irregular) and I observe at time of surgery that the labrum appears hypertrophied (to compensate for lack of head coverage) and often torn. Fewer narcotic medications are administered, resulting in a better overall recovery. I also have undiagnosed neuropathy in both legs from the knees down. They thought it would give me about 5 yrs. Over time, some patients may acquire sensitivity or an allergy to the metal particles produced by the metal ball and socket. I didnt spend time on boards talking for eons about peoples outcomes.probably a good thing I didnt. I am deciding that my quality of life is in the toilet and need to get the THR done. I exhausted all other non-surgical options, such as physical therapy and meds but to no avail, so now plan to have a THR in March. I have the hospital but am deciding on the surgeon and which approach is best. 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. Clearly, he or she has earned your respect and confidence. How do you ask your doctor the questions you want to ask? It all comes down to the surgeons comfort as well as the patients. If you were in Los Angeles and needed a THR who would you choose to do your surgery? It's a hip replacement surgery where you lie on your side. You can check these in your browser security settings. Hip Replacement Surgery | Superpath Hip Replacement Sydney Australia You helped me tremendously in my research of the track record of my HMO, now I have one more quick question to run by you. Thanks. Thanks, What To Expect From Anterior Hip Replacement Surgery & Recovery I am a South African and need to make a decision on whether my mother (69) goes for an AMIS or traditional posterior. Felt very uninformed and left There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. Choose your surgeon and not the approach or prosthesis. Cant afford a dislocation or other complications cause Im sole caregiver for severely handicapped son. All orthopaedic surgery demands a long recovery period. Which approach did the doctor take? Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. 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. A long surgery time, on the other hand, was also associated with DAA. What is your experience and take on this ? The femoral nerve functions to extend the knee and also is responsible for sensations over the anterior and medial aspects of the thigh, medial shin, and arch of the foot. The doctor used the posterior procedure. We can do this because of improved plastics. My surgeon is doing posterior and my reason is I am self employed with limited Time off available and hope to be back to work at least walking and driving in 4 to 5 weeks is this possible? The mini posterior approach works wonderfully and predictably when expertly performed. I think its reasonable to request a tour of the facility where youre considering having the procedure. 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? Ill know a lot more after we meet and I review your X-rays. SuperPath Hip Replacement Surgery Chesterfield | SuperPath Hip Surgery Common conditions that often lead people to have either posterior or anterior hip replacement surgery include the following: Osteoarthritis Rheumatoid Arthritis Osteonecrosis, also known as Avascular Necrosis Injury Fracture Bone Tumors Many also mate this with a ceramic femoral head. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. Unfortunately, injury to the lateral femoral cutaneous nerve is a common complication after the anterior approach for hip replacement. It also is more difficult for patients with some patterns of arthritis such as protrusio, which causes the worn out ball to migrate inward rather than upward into the socket. Update what hes cutting is the adductor so my question is the same is this just a normal part of some THRs? Here are a few of the advantages of anterior hip replacement. Spring 2014 had trouble playing tennis, hip kept feeling like it was popping out of joint, groin pain, aching. Minimally Invasive Total Hip Arthroplasty Technique - Medscape Dr. Robert Sigmund is a board-certified orthopedic surgeon and a sports medicine physician based in St. Louis, Missouri. I was told the joint lubricant had migrated into the hip bone creating the cyst, There is effusion in the joint and stress areas. This does not necessarily mean they will have more pain or take longer to get well. What is most important is that you find a surgeon who understands the particular complexities with your problem and whom you trust. How would a hip replacement be done? 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. I also regularly receive Rolfing treatments which has helped me manage pain and maintain what mobility I have. The surgeon was not at the pre-op meeting, but the PA assured me it was not that big of a deal (but to me, ALL surgery is a big deal!). Why is that? I also would encourage pool walking or swimming. We are always refining and trying to make it better. A shorter hospital stay and faster recovery are typical of this because there is less damage to the muscles. Most patients are able to walk the day of surgery. Posted General comments will be answered in as timely a manner as possible, Hip & Knee Surgery The anterior approach typically does not violate this structure. 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. 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. In my practice, I cement an Exeter stem in a significant percentage of my patients who undergo THR . Thanks. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. 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. That means you have an excellent track record. I have a tilted sacrum, sway back and a very large posterior. I weigh 185 and am 54 and realize its ideal to lose weight prior to surgery (working on it as always). What Ive seen in my practice is that the more total hips I do, the less restrictions I place on my patients and the more active my patients are. The anterior approach has a lower incidence of sciatic nerve injury and a higher incidence of femoral nerve injury. I also would learn about the track record of the surgeon and hospital where you will decide to have the surgery and what implant will be used. Dont let PR marketing confuse the big picture. About this injury to me. Consult an orthopedic surgeon who specializes in hip replacement surgery if you have a hip problem. Complications Advantages of an anterior approach to hip replacement A major muscle is not cut during the anterior procedure. 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. We want the forums to be a useful resource for our users but it is important to remember that the forums are 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. What is SuperPath Hip Replacement? The surgeon I expect to use does the Direct Anterior approach. Minimally-Invasive Total Hip Replacement Surgery I wish you the best of luck. Most receive a simple spinal with sedation. During the hip replacement procedure, the surgeon makes a small incision near the front of the hip to allow for the removal of damaged anterior bone and cartilage, as well as the implantation of an artificial hip without damaging the surrounding muscles and tendons. Will I still be able to do the things I like to do? Thanks so much for this information! Finally, hip replacement surgery is expensive and may not be covered by insurance. If its a struggle, then the situation needs to be reassessed. You are free to opt out any time or opt in for other cookies to get a better experience. July 2013 my left hip was scoped for a labral repair. You should consult with your doctor before deciding to have an anterior total hip replacement. There is a possibility that blood loss may be reduced as there is less unnecessary exposed bone surface left to bleed. Following the anterior approach, we provide you with a number of precautions and positions that you should avoid if you are in danger of being discomfited. Dr. William Leone. The initial recovery period typically takes six weeks or more. SuperPath Hip Replacement - SuperPath St Louis | Orthopedic Surgeons Thank you for this! SuperPath Hip Replacement Baton Rouge | SuperPath Surgeons Baton Rouge I had no inkling of this till he showed me on the x-ray. Finally, hip replacement surgery is expensive and may not be covered by insurance. I saw a surgeon who does the posterior approach only and will see another on 4/14/15 who does both approaches. Have you heard of something like this, and if so, is it worth it? Usually a hip problem is addressed before a knee or foot problem because by solving the hip problem first, the knee or foot often improves if the pain is referred from the hip (more common with knee pain) or if by addressing the hip, the body mechanics and the fluidity of gait improve. My surgeon has told me I will need PT 3 times a week for 6-12 weeks is this too long? 2015 Aug. 3 (13):179. Complications from infection account for approximately 10% of all cases. I wish you only the best. Also there are concerns about disruption of blood supply to femoral head with this operation. 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. But this will always prompt you to accept/refuse cookies when revisiting our site. Thank you, Lisa. 5 Things to Know About Anterior vs Posterior Hip Replacement The surgeon I am meeting with (Dr Jimmy Chow) is supposed to be top notch in this procedure, and I am just curious as to how different the surgery is from conventional surgeries. I would encourage you to discuss your concerns with you surgeon. Orthop Clin North Am. Even after the procedure is completed and the patient is on pain medications, pain and discomfort may occur in some cases. However, some offer greater patient benefits than others. J Orthop Surg Res. It is a mix of anterior & posterior. I understand and respect that many surgeons prefer doing them simultaneously. People who have anterior hip replacements tend to stop using walkers, canes, and other aids 5 to 7 days sooner than people who have conventional hip surgery. Dear Dr. Leone, Because the femur is more difficult to expose during the anterior approach vs. the posterior approach, many surgeons will select a shorter femoral component to facilitate reconstruction and lessen chance of fracture. If a patient has abnormal anatomy (such as dysplasia, posttraumatic arthritis, or morbid obesity), or if their body mass index is higher than 35, it may be impossible for them to be considered for direct anterior surgery. 2021 May 20;16(1):324 . 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. Are expected to be out of bed (hips and knees patients) the afternoon of their surgery and at least taking a few steps if not walking. It exploits the inter-muscular interval between the tensor fascia lata and the gluteus medius. There are hybrids of the surgey from what I can see. Hip replacement is a fantastic operation that can help relieve pain, improve daily function, and improve quality of life. A hip replacement is the most common cause of complication in about 20% of cases. 3. 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. Thanks for any feedback. I just saw a patient with a femoral neuropraxia after a anterior approach THR. In my experience, the restrictions (or those positions we ask our patients to avoid after surgery) have become much less limiting and are off limits for a much shorter period of time. 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. Gililand, our physician, explained the concept of health. I would not change the position of the components. This then becomes a very difficult problem to solve. An anterior hip replacement does not have any limitations based on comfort. I was not aware that any of the local surgeons who is doing anterior approach. I would discuss fully your goals and concerns. As a result of anterior hip surgery, there is little need for any special care. Will I still be able to do all of these things? Thanks so much for your help, very grateful. Problems such as osteoarthritis, rheumatoid arthritis and avascular necrosis can destroy the protective cartilage around the hip joint, disrupting the smooth contact between the femoral head (ball) and hip socket. I havent dropped in here for a while but here I am almost 5 yrs post op Anterior and Femoral Nerve Damage is very alivewhole thigh is numb, IT band is still very sore and numb. The first is that it is a major surgery, so there is a risk of complications such as infection. Contact Us, Approaches from publication: Current and . I had an MRI by a different hip doctor (a preservationist) who diagnosed me with a birth defect (hip dysplasia). Even though I was positive I wanted this method done, I was still questioning my decision. It is important to consider the SuperpathTM technique if you are considering a hip replacement. Problem is that we have seen two doctors and both seem great but are on two extreme sides of the fence. SuperPATH Total Hip Replacement Phoenix, AZ | Total Hip Replacement Arizona You should feel good that you are aware of your fears and that it hasnt paralyzed you into not acting. Results of the surgery numbness in the right thigh, inability to stand on the right leg, muscle atrophy all confirmed by EMG and second orthopedic surgeon. I dont want a long recovery time as I am very active. When it comes to revision surgery, we rely heavily on the posterior approach. 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. Thank you so much for your answer, I appreciate your taking the time to care about others. What are the experiences of other countries with THR? [QxMD MEDLINE Link]. Better luck to you all. Good question. By continuing to browse the site, you are agreeing to our use of cookies. Cons of Robotic Assisted Surgery As with any type of procedure, Mako is not without its drawbacks. Fitness going into surgery and speed of recovery seems to be a common theme though. I think they are happier and rehab more quickly. What is SuperPath hip replacement? Before proceeding, it is a good idea to review the recommendations and specific parts that your surgeon may recommend. Most patients decide not to wait as long to have their contralateral hips or knees replaced after having undergone a successful surgery on the first side. Just need reassuranceI am stressing he is fine. You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. Patient is a UK registered trade mark. What is the best hip replacement option: anterior or Posterior? I had good results into 5th month post op and then everything went downhill. The bone isn't dislocated in surgery. The majority of teaching institutions in the United States continue to instruct as well as perform the traditional posterior as their primary approach. 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. It is also possible to have an anterior hip replacement during pregnancy. But Im impressed with your blog and responses, so am writing to ask you about an apparently new procedure in which the surgeon uses a customised implant, utilising pre-operative 3D CT scanning. William Leone. 3 years ago, It is difficult to get that from information which I find curious. Both have valid cons against the others methods and pros on their method. 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. The parts may be attached to the bones in one of two ways. Lastly, if one has had P or AL is there anything that can be done to offset the need for restricitons? I deal with OA lower back mess so know I see most likely how all this has played into the surgery. SUPERPATH Hip Replacement | Bethesda Orthopaedic Institute The earlier the recovery begins, the better chance for a more-complete recovery. According to Dr. Rosen, the most important thing to remember is what you leave behind rather than how you get there. It is generally agreed that the temporary numbness is more than balanced out by the substantially improved recovery, reduced pain, absence of a limp, faster return to function, and virtual elimination of the risk of hip dislocation. Does Medicare Cover Hip Replacement Surgery? - Healthline I try not to let it get to me, but it causing me to feel handicapped. I began using the superior approach for total hip replacement in February of 2014. . It will help desensitize and help get your muscles working in synchrony. I have two questions one, how realistic would it be to try to have both hips done at the same time? The mini posterior approach essentially is the same as the traditional posterior, however a smaller incision is made and less soft tissue is exposed. The first surgeon never mentioned this condition at all. 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. As a result of this precaution, it is difficult to sit on low chairs, sofas, or toilets. Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. Is THR something that can help? Soft tissue contractures often are associated with long-standing arthritis. How does it affect the actual success of the disadvantages of superpath hip replacement. Ten out of every fifteen hip replacements will be functional for more than 20 years after they are inserted. Finally, I would choose a doctor with whom you connect and whose staff is engaged and knowledgeable. Any feedback will be appreciated. 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. Some of the most common considerations are age, weight, activity level, and the presence of other health conditions. I am a 73 year old woman who has been having severe hip pain for the last seven months. My surgeon mentioned also cutting something to free me up at the same time he will be doing the posterior approach surgery. Thank-you. Would appreciate any input you might have on the auto immune issue, and weight etc.
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