Always speak to your doctor before acting and in cases of emergency seek Some surgeons believe that a patient who is neither obese nor overly muscular is a good candidate for anterior hip replacement surgery. I am terrified of nerve damage as I am very athletic and a previous professional ballet dancer. The amount of PT you need after surgery will be determined by you and your surgeon. Dear DR Leone, disadvantages of superpath hip replacement The development of a complete and secure surrounding scar tissue wall or pseudo capsule is critical for stability. Pros and Cons of Robotic Assisted Surgery - Carrothers Orthopaedics It is not a substitute for excellent surgery. An anterior-approach hip replacement necessitates a small incision in the groin area on the front side of the leg. My gait is off partially due to my hip but also I believe because of my body structure. Uncemented. A couple of things I am hoping you will explain using laymans termology. The new prosthetic socket must be medialized (placed further toward the midline) and sometimes through the medial wall of the native socket. 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. A lot of hospitals and ambulatory surgical centers offer what's called outpatient surgery. All have advantages and disadvantages. I recently had a spontaneous hip fx and was diagnosed with hip displasia. Hip Replacement | Rush System If you decide to have your hip replaced in another country, I would consider carefully who would care for you if you develop a complication such as an infection, or a major medical problem like a pulmonary emboli or heart attack after surgery. I understand and respect that many surgeons prefer doing them simultaneously. 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. Hip Replacement Materials Best to Worst - Bioxcellerator The incidence of dislocations has further decreased over the past decade with our ability to implant larger size femoral heads. Personally, I would not gamble with my health. It is a mix of anterior & posterior. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. Should I be though? Hips that are out of joint have an anterior hip replacement. It sounds like he did fabulous job. 1000 NE 56th Street, 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! The leg lifts really aggravate the front of the hip. After the direct anterior approach, there is generally no hip precautions required, and motion is not restricted. Thank you. It can lead to numbness in the thigh and, in rare cases, skin irritation due to the nerves presence. Surgeons do not cut across muscles. Both problems are on the right side of my body. Back to work/driving in 10 days. Dear Dr. Leone, A modern artificial hip joint is designed to last for at least 15 years. There is less risk of neurological injury. Please do not take this as an attack, but your article seems biased on your experience (great results with min. I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. Types of Hip Replacement (Approach) Hip replacements can be preformed through a direct anterior approach, an anterior lateral approach, a lateral approach, a posterior approach, and a superior approach. Our insurance covers both. Can You Use An Inversion Table With A Hip Replacement My doc said the angle of my hips is not the worst but also not the best. Thank you for this information. I would research and find the physician and hospital that will give you the best chance of doing well. Many modern-day femoral stems are considerably smaller or more bone sparing than well-functioning stems of the past. SUPERPATH Hip Replacement | Bethesda Orthopaedic Institute It also helps to stabilize the acetabular shell and prevent soft tissue irritation on the out edge of the cup. The doctor is planning a traditional posterior. How long will my hip replacement last in your opinion? 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. Some patients have no pain at all, which is remarkable. I wish you a full recovery. Femor fracture. Pain Management I believe a THR will benefit you tremendously. My question is, I am a very active 67 yr old. Surgical Approach Types | Hip Replacement | Elvis Grandic, MD Blood-thinning medications can reduce this risk. I have two questions one, how realistic would it be to try to have both hips done at the same time? more nutritious, too. Can you please on the various points in the post and perhaps also elaborate on the last point. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. 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 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. All: I would not anticipate them improving with time, but rather worsening, and I cant imagine you being able to resume the activities you described without having surgery to treat this. No feeling in my leg and no movement Rather, they say Bill, please just do what you have to do and do a great job. Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. 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 posterior approach is used frequently again, in large part due to the fact that it is an extensile approach. A mini posterior approach is a modification of the classical posterior approach. Dear Mary, The most important decision you must make is choosing your surgeon. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. I think its reasonable to request a tour of the facility where youre considering having the procedure. If possible, speak with other health professionals who work at the hospital or at least in the same geographical area. Woke up with A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). A major hip replacement can take up to four months to fully recover from. Clearly, he or she has earned your respect and confidence. I had to cut some strength exercises out leg lifts, hip sled. I dont know what happens on that tablewas he in a hurry on Friday afternoon. Each question is scored from 1-5, with 1 being no problems and 5 being severe problems. Most of my patients now go home the day after their surgery or the next. I am already limping when walking and was hoping that the limp would disappear after the hip surgery. I came home with crutches, abandoned them at the front door and have not used them since. I understand they have good results in Thailand or India for half that. The surgeon does about 200 a year and people say he has a good reputation. Does my prothesis not last as long since I am now doing a 3rd surgery? I had no inkling of this till he showed me on the x-ray. I still have a very big limp and still undergoing physical therapy. We thank you for your readership. 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. By adhering to the surgeons instructions as well as their pre- and post-operative instructions, you can reduce your chances of complications. Any info would be appreciated. Had a total hip replacement aug 2013. I really dont know where to go from here. Because these cookies are strictly necessary to deliver the website, refusing them will have impact how our site functions. Additionally, there is a small risk of dislocation after surgery, which can be painful and may require additional surgery to correct. Tossed the cane at three weeks and went back to work. So my question is in relation to my body structure. These other conditions need to be defined and hopefully ruled out as the primary source of pain. Many wonderful physicians are part of various HMO panels. Complications associated with an anterior approach hip replacement are similar to those associated with standard hip replacement surgeries. Posterior or Anterior? 3. I live in Staten Island and need rt hip replacement. I was thinking of a Hip Resurfacing for my left hip and was convinced by my other top hip surgeons to stay away from it. Optimal component positioning also is critically important for the best stability and longevity. Dr. Himmelwright Introduces SuperPath to OIP I assume PTHR is referring to partial hip replacement. 3. What do you mean by painful anterior scarring and soft tissue exposure and trauma? I do participate in competitions and showcase presentations. Gililand, our physician, explained the concept of health. Some of the most common considerations are age, weight, activity level, and the presence of other health conditions. Similarly, an engaged medical team needs to be available to help with care after surgery. Some in the early period have good track records, others do not. Many also mate this with a ceramic femoral head. invasive posterior vs not so good with AMIS) whilst on the other hand, with one of your replies you state that surgeon experience should be considered with AMIS success rates and in other replies stating that both alternatives are good. This left hip remained tender based on my exercise level which I did modify but always my hip had some soreness. The mini posterior approach works wonderfully and predictably when expertly performed. 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. The surgeon I went to said he does THR using a lateral approach. We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. I wish you only the best. 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. 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. SuperPath Total Hip Replacement - STL Ortho This site uses cookies. Hip replacements might keep you out of action for a considerable period. I think researching the hospital where you will have your surgery is very important. Regarding restrictions after your hip replacement, this too is an area that has changed drastically over my 25 year career. Infection. Nobody wants a long recovery. Dr. William Leone. I wish you the best of luck, Testimonials Also, how about hip restructuring instead of Total Hip Replacement. Your frustration is completely understandable. I am 37 and have suffered from AVN since I was 14. Does either procedure in this discussion present restrictions or advantages for this sort of movement? Most of the restrictions are removed at that time, although I still advise common sense, particularly for the first three or four months. I would emphasize choosing your surgeon and not the approach. The SUPERPATHTM procedure provides a number of advantages over traditional hip replacement surgery. Losing weight and strengthening your muscles pre-operatively will make surgery easier and greatly facilitate your rehab. Over the years, these precautions and the length of time to adhere to these limits have been challenged both by clinicians and patients. I would encourage you to discuss with your surgeon the difficulties and pain you experienced after the first surgery, and together explore if another plan can be created for a better outcome the second time around. Im considering this mini posterior approach. What determines the differences? Introduction I have since read that hips with this condition might get worse after labrum repair due to this structural defect. Choose your surgeon and not the approach or prosthesis. Following surgery, the surgeon will devise a routine for the patient to engage in that is both comfortable and safe. Over time, some patients may acquire sensitivity or an allergy to the metal particles produced by the metal ball and socket. Thanks again for this great blog! Hip Replacement Surgery & Recovery | University of Utah Health 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. With SuperPath, there is no surgical dislocation of the hip. Although anterior approaches can be useful for some, they are not for everyone. 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. If you feel confident in your surgeon, I would discuss it frankly follow his or her guidance as to which approach and prosthesis are most appropriate to give you the best result. Thanks again! Most patients are able to walk the day of surgery. Every hip implant has benefits and risks. Click on the different category headings to find out more. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. Pain and disability are reduced. 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. My surgeon uses the posterior approach. Your article has made it clear I made the correct decision, especially since my daughter had nerve damage from an operation years ago. That's all I know. Disadvantages of the anterior approach include: Although I am trained in both approaches and have trained surgeons in both approaches, I have stopped using the anterior approach because I saw my patients get well faster, bleed less, and have a more predictable result when I performed the surgery using a mini-posterior approach. Being cared for in a hospital that specializes in joint replacement and has an extensive specialty medical staff also is key. Also, is it immoral for an 80 year old to have THR and cost the nations health care system $25 $35k? That's all I know. I have read your articles about procedures (anterior vs posterior). 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. Thank you so much for taking the time to inform us! I am scheduled to have total hip replacement surgery in 2 weeks. I tore my labrum at age 43 and only discovered then that I had bilateral dysplasia. Contact Us, Approaches Extensive release of the posterior capsule including . I love that you take time off to reply to these messages it is commendable. What is SuperPath hip replacement? It exploits the same soft intervals but it typically accomplishes prosthetic implantation and soft tissue balancing through a smaller incision and, more importantly, with less underlying soft tissue dissection. 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. I am unsure whether the minimal invasive posterior is available in SA. I wish your patient well. We now have too many other proven bearing surfaces available. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. Bleeding at the operative site can occur as a result of an anesthesia reaction, such as an allergic reaction. I wish you well. Patient Concerns Currently, I seldom do bilateral THRs under a single anesthesia but instead stage the surgeries 2 1/2 to 4 weeks apart, depending on my particular patient and his or her needs and desires. Today, everything from tools to techniques has improved. 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). Im a 50 year old female whose been dealing with hip, leg and back pain for many years, recently diagnosed with OA, and finding that I need a right THR. It is so important to stay focused on the outcome of your hip replacement surgery: excellent results both short- and long-term with minimal risk of injury or complication, and not lose sight of the real goal, which is to create a perfectly positioned reconstructed hip that is stable, balanced and has the best possible chance of lasting more than twenty years. Click to enable/disable _ga - Google Analytics Cookie. Hip Preservation Surgery | Duke Health Personally, it I were caring for you, I would have advised you exactly as the orthopedic surgeon who took care of you did. If so, how long until I can get back to normal living? I'm hoping to read some posts post surgery. I am thoroughly confused at this point. SuperPath approach is the least invasive due in part to the minimal amount of tissue damage. It exploits the inter-muscular interval between the tensor fascia lata and the gluteus medius. I suspect that your surgeon has continued to refine his or her technique based on experience over the past five years, in the same way I have. These positions include crossing your legs, bending your hip more than 90 degrees, or lying on your stomach. Your back does need to be evaluated as well. I then would trust your doctor to select the prosthetic that would deliver the best result according to your goals and allow you to return to activities that you enjoy. Report / Delete Reply kelly1010 nicole66881 It will help desensitize and help get your muscles working in synchrony. Choosing a surgeon should be based on published data (if available), as well as his or her reputation in the community, according to Dr. Delcore. United States. The first step to rule out infection is to have two simple blood studies done, an ESR and CRP. The approach planned is a frequent topic of Continued There does appear to be an increased incidence of stem instability when implanted through the anterior approach, but I believe this is largely a function of the surgeon experience. Patients who work for themselves are very motivated to return to work and often do so between procedures. Get Directions, Phone: 954-489-4575 My question is, what will my restrictions be? Our second opinion doctor performs traditional and Birmingham hip replacement. Now 1 yr later dont have buckling/giving out but a lot of pain is there and after walking around, after about 20 minutes it hurts to lift leg forward, also good hip starting to hurt. Historically, higher dislocation rates were reported with the posterior approach, but it still was used for its many other advantages. 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). Its Inosine and Sphingolin. Dr. William Leone, Hello Dr. But this blog was a nice nudge toward the posterior. Dr. William Leone. Its been a couple months and I thought Id drop in with an update..over 4 yrs post op and I deal with Femoral nerve damage from Anterior, and found others who deal with the same.it may lessen with more years but who knows.Somewhere I read 15% or so end up with this..I talked 2 other people in my city, same surgeon and they have had this issue to. A less stringent set of precautions is required with the anterior approach. What is SuperPath Hip Replacement? 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? Advantages of this procedure include: The direct anterior approach involves dissecting between the natural intervals of the two main muscles located at the front of the hip and upper thigh. 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. Thank you. I would consider talking to other patients who had their hips replaced by that physician and learn about their experiences. Thanks. I wish you the best of luck with your care. He is one of the few surgeons in the U.S. that performs total hip replacement via a superior capsular approach, the most soft tissue-sparing hip replacement available and is an industry educator in the . I spoke in person to probably 4-5 of his success patients and went with hearing from them. Im now 6 weeks out and doing good. The incision made for the operation can be as small as three inches. not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in I wish you a full and uneventful recovery.

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