All have advantages and disadvantages. 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. Also, I am diabetic and have had two organ transplants and am extremely worried about infections, etc. Otherwise you will be prompted again when opening a new browser window or new a tab. An anterior-approach hip replacement necessitates a small incision in the groin area on the front side of the leg. The anterolateral approach or Watson Jones approach is one of the classical hip approaches that can produce excellent results when utilized for THR. Evidence review for hip replacement approach - NCBI Bookshelf In anterior and posterior surgeries, the outcome is essentially the same a new hip. Click on the different category headings to find out more. The rest is marketing. What is the best stem and ball/socket combo to use for someone that ones to play tennis? You are free to opt out any time or opt in for other cookies to get a better experience. I advise both my total hip and my total knee patients to avoid repetitive impact activities like distance running. Thank you for sharing with others the nerve supplements that youre finding affective. There are potential drawbacks to anterior hip replacement. I will let you in on something personal. 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. Also I have read that there is a sharp learning curve that must take place in order to do the direct anterior approach. The hip is replaced without the need for surgery to dislocate the joint. I walk a lot in my job and bend lots (work with children) and sitting causes pain due to impingement. Possibly, its secondary to an altered gait pattern or hip mechanics. Following surgery, the surgeon will devise a routine for the patient to engage in that is both comfortable and safe. I am looking at how many hips they have done and where they are doing them. It was discovered that I had a torn Labrum. 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. Its been 9 months(Ive had it 2xs bf and got rid of it and have tried everything and no results this time). It does mean the surgeon has lots of room to move about though!! 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. After reading your article I am concerned about the issues you discussed. I would discuss fully your goals and concerns. Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. I dont want a long recovery time as I am very active. Pam. In general, people who are older, heavier, or more active may not be good candidates for this type of surgery. 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. Check to enable permanent hiding of message bar and refuse all cookies if you do not opt in. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. SuperPath Hip Replacement: The Major Benefits I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. Losing weight and strengthening your muscles pre-operatively will make surgery easier and greatly facilitate your rehab. Advantages and Disadvantages of Anterior Hip Replacement If I think you may be a candidate, I will refer you to a doctor in our area that does. A hip replacement can greatly reduce the pain associated with arthritis of the hip, with almost all patients having complete or near-complete relief. Hi, Other preoperative guidelines, such as using a prescribed pain medication and keeping the incision clean and dry, should also be followed by patients. I suspect there is significant underlying osteoarthritis related to your labral pathology. At the end of the day, I promise, it is not the approach but rather the person who is doing the surgery. 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]. Sometimes during surgery it is necessary to release particularly tight structures to expose the joint for reconstruction or to better balance surrounding soft tissues after reconstruction. 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 Im hearing no restrictions (once recovery is done) for Anterior, but always some for the other two. I went with a total hip replacement. Very few metal-on-metal bearings are being placed today due to the serious potential of metallosis. Uncemented. 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. 1.2. Sometimes, it simply isnt possible to accomplish. William Leone. Total hip replacement is one of the most successful operations ever developed and is a remarkably predictable way to relieve pain from arthritic conditions. In 2013 I had a THA done on the left hip. There is less blood loss with a single THR than a bilateral, hence less risk of needing a transfusion. Patient is a UK registered trade mark. The bone isn't dislocated in surgery. If possible, try to get in writing any verbal promises made. Personally I had the posterior approach and cannot see how I could have recovered any faster . The leg lifts really aggravate the front of the hip. Every . In my experience, after four to six months most patients simply return to normal activity. Depending on the stability and range of motion observed at time of surgery, some doctors dont advise their patients to avoid any positions. I would rather my patient get half as much anesthesia. 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. No specifics were given to me from the orthopedist . The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. I am planning to have a THR this summer. An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. I have cared for many patients over the years with significant heart and peripheral vascular disease. It is much better to precisely release and cut rather than tear or fracture. If you do not have a hip replacement, you will live a sedentary lifestyle and become overweight. In the hands of a master, all can produce wonderful and predictable results. No Muscles Cut is for billboards. My husband has a plastic valve (done in 86) and synthetic assending aorta and triple bypass (done in 2013)very successful surgery. However disadvantages include the inability to adjust for leg length differences and a relatively high risk of femoral neck fracture. Thank you, Lisa Blumthal. It is normal to want to recover quickly and return to a very active lifestyle without pain. 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. 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. What has changed the most in my career, once again in a very positive way, is how quickly patients start walking (day of surgery), and go home and return to their active lives after THR, as compared with just a few years ago. Every hip implant has benefits and risks. In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. It is important to understand that "less invasive" does not only refer to the incision but . Hip replacement - Doctors & Departments - Mayo Clinic This often leads to a less than optimal component position. . Most doctors have and continue to implant hips through the posterior approach. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. Start your day off right, with a Dayspring Coffee I worry that replacing it with a differently configured socket could make things worse rather than helping. We are always refining and trying to make it better. I am totally confused and dont know which procedure to choose. Surgeons do not cut across muscles. I assume PTHR is referring to partial hip replacement. With mild dysplasia, positioning and implanting the new cup usually is not more difficult than with other conditions. Having a hip replacement using SuperPath keyhole surgery Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? Conclusions SuperPATH approach showed better results in decreasing incision length and early pain intensity as well as improvement of short-term functional outcome. I am not sure that is true any more. There is less risk of neurological injury. An anterior approach hip replacement is one of the most minimally invasive surgical options for replacing a hip. Introduction. This means you could go home within 23 hours after surgery. One advantage the ceramic-on-polyethylene carries is the lack of . According to Dr. Rosen, the most important thing to remember is what you leave behind rather than how you get there. You can check these in your browser security settings. With SuperPath, there is no surgical dislocation of the hip. I would encourage you to discuss your expected recuperation time and specific restrictions with your surgeon. Some patients have no pain at all, which is remarkable. The hip replacement needs to correct the abnormal hip mechanics that lead to the arthritis. Its been my experience that patients who go into surgery well informed have a better experience and seem to rehabilitate more quickly. Consult an orthopedic surgeon who specializes in hip replacement surgery if you have a hip problem. Once you find that doctor, then you need to put your trust in him or her to help you solve this horrible problem so you can return to being active and productive. I am so sorry to learn that you have had such a bad experience after THR. It is possible that you will be required to avoid certain high-impact activities to protect your new hip. The vascular supply of your leg must be assessed preoperatively as part of you work-up, but most do very well. Orthop Clin North Am. Should I be though? The vast majority of my patients return to work one to three weeks post-operatively. The incidence of dislocations has further decreased over the past decade with our ability to implant larger size femoral heads. J Bone Joint Surg Am. Thank you for sharing. You can be successful by staying healthy by sticking to less pain. A shorter hospital stay and faster recovery are typical of this because there is less damage to the muscles. Celle said: Superpath may give you a faster early recovery, but whatever method is used, recovery is still going to take a long time. Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. I dont know if this stems from the knee surgery but I do not believe so because I was well for about a year and a half. Hey, thanks for the forum topic.Thanks Again. Email us. My surgeon uses the posterior approach. I am a competitive tennis player in my age division. Supercapsular Percutaneously-Assisted Total Hip surgery or SuperPATH surgery is a novel method of hip replacement where your surgeon can perform total hip replacement through 2-3 inch incision into the tip of the hip and without dislocating the hip or damaging the surrounding soft-tissue (muscles and tendons). Even though I was positive I wanted this method done, I was still questioning my decision. It is 100 percent normal and expected to be scared before surgery. 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. Every prosthetic joint has a mechanical range of motion. I would anticipate that you would be able to return fully to your activity once the tissues around your total hip heel. If so, is it possible to have both hips done at the same time? They may have a certain cut-off criteria (for example, a BMI of less than 35). Bleeding at the operative site can occur as a result of an anesthesia reaction, such as an allergic reaction. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. My hope is that some of these symptoms will improve with time. Clearly, he or she has earned your respect and confidence. 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. The only problem Ive had post hip replacement is some on/off again groin pain. Walking is the best exercise. Clearly, yours was. I weigh 185 and am 54 and realize its ideal to lose weight prior to surgery (working on it as always). But I am now in chronic low grade pain thats getting worse and dont know what I should do. I am sure you should not listen to what I did!! 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. Also, because technically it is easier, many patients are being reconstructed with very short stems which are press fit into the bone during an anterior approach. I wish you a full and speedy recovery. The nerve which supplies sensation to the front and side of the thigh is vulnerable. There are 5 questions, mobility, self-care, usual activities, pain and anxiety. I am a 67 year old woman who has danced semi-professionally and has always been very active including doing Ashtanga yoga and caopeira. Years ago, experts assumed that anterior hip replacement had lower rates of hip dislocations and nerve damage than other forms of hip replacement. Also, when a single joint is replaced versus bilateral, there is significantly less bleeding and hence a much decreased need for transfusion. External rotation of your feet should be limited (avoiding them twisting to the outside as Charlie Chaplin does) and hip hyperextension should be avoided. Changes will take effect once you reload the page. 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. i had lateral posterior, my surgeon stopped doing anterior because he said it caused muscle problems moving them about and can also cause nerve damage, which is the main reason I did not want that approach. It requires surgical insight and skill to accomplish. Which is the best? A ball and socket are used to connect the new joint to the thigh bone (femoral bone), which is made of metal, plastic, and ceramic. My doc said the angle of my hips is not the worst but also not the best. This robotic technique can assist in producing an excellent result. 2. Thank you so much for taking the time to inform us! The second most-common injury is to the femoral nerve. This left hip remained tender based on my exercise level which I did modify but always my hip had some soreness. 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. Dr. William Leone. I had an anterior right hip replacement in late 2010, I was 72. Do I have a high percentage of hip dislocation after a 2nd revision done posterior way if so what is my chance of another hip dislocation even if I do the surgery again? It is also important to avoid any sudden movements or twisting motions. We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. I'm hoping to read some posts post surgery. How do you ask your doctor the questions you want to ask? Very slow recovery. disadvantages of superpath hip replacement - homelessnest.org Ceramic-on-polyethylene is currently the most popular hip replacement material, representing 50.6% of all hip replacement cases back in 2014. The surgeon accesses the hip joint from the front of the hip, rather than from the back or side. I think its reasonable to request a tour of the facility where youre considering having the procedure. What you can do is keep as good an attitude as possible and keep rehabilitating your leg. There is a 1-2% risk of fracture of the femoral neck. Pain is almost gone and I am beginning to get back to my life. Or are x-rays definitive for determining the exact reason for THR? The best of luck to you, 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. The risk of revision surgery after a posterior hip replacement is the most serious concern. 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. 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. Will meet with doctor soon but when I was finally able to really exercise after surgery I overdid it and developed plantar fasciitis. 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. Would you recommend treating plantar 1st? Fort Lauderdale, FL 33334 The Hanna bed, general anesthesia machines, spinal setup, medications, ventilation, instruments, and their sterilization are all prerequisite. Over time, some patients may acquire sensitivity or an allergy to the metal particles produced by the metal ball and socket. Can you please on the various points in the post and perhaps also elaborate on the last point. I ride horses, water ski and kayak. Im sorry to hear that you struggled after your first, anterior-approach THR. Hip Preservation Surgery | Duke Health Hard-on-hard bearings, such as ceramic-on-ceramic as well as metalon-metal articulations, also resulted in larger femoral heads being implanted. 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. Hip Resurfacing vs Total Hip Replacement - sosbones.com Walker to get around. SuperPath Hip Replacement (Surgery) : 3D Animation - YouTube I had an MRI by a different hip doctor (a preservationist) who diagnosed me with a birth defect (hip dysplasia). If your X-rays reveal that you already have bone on bone due to osteoarthritis, then you typically dont need either an MRI or Pet Scan, unless another diagnosis is suspected. My surgeon has told me I will need PT 3 times a week for 6-12 weeks is this too long? Is THR something that can help? Pain and disability are reduced. The source of your hip pain must be diagnosed. Simply, we keep trying to get better. For centers like Phoenix Spine and Joint that use a robot, there is . Click to enable/disable Google Analytics tracking. Operating through too small an incision and not releasing tissue that would improve exposure and result in a more balanced joint in my opinion does a disservice. He strongly recommends the anterior approach as the only way to go. Doc says once recovered I should avoid flexion with adduction and internal rotation. Recognize that the underlying etiology is not being corrected by this procedure, so relief of symptoms probably will be temporary and possibly partial. His hip ball was put back in the socket and he has done beautifully since. He is the founder and main author of brandonorthopedics.com, a website that offers valuable resources, tips, and advice for patients looking to learn more about orthopedic treatments and physiotherapy. Do you also do arthroscope surgery? Dear Dr. Leone, Going in for THR in July. My main concern is that I have a tilted sacrum and a very sway back. It also keeps the surrounding muscles and tendons in place to reduce the risk of post-op pain and nerve damage. Do I have a risk of fractures during a posterior right hip revision due to my prior complications already? Because the muscle fibers are separated, not cut, the nerve path is not disturbed and the muscle is not injured. I have not seen this before because in the past, the complication from hip surgery were sciatic nerve injury from posterior approach. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. Regarding restrictions after your hip replacement, this too is an area that has changed drastically over my 25 year career. I understand and respect that many surgeons prefer doing them simultaneously. Of note, I am a RN with 30 years of experience and took this decision very seriously. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. 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. I saw a surgeon who does the posterior approach only and will see another on 4/14/15 who does both approaches. As long as you do the necessary surgeries, you will eventually break your femur, but only if you do enough. The femur is prepared with the head and neck intact reducing the chance of fracture. I live in Staten Island and need rt hip replacement. Do you have any thoughts on this issue? I plan to retire from working full time June 2017 and am concerned about having appropriate insurance after that. Some patients report that symptoms increase in the not-yet reconstructed hip because of the leg length inequality. In another day I was able to take short walks without any limping, etc.. Until now. It's cut off and removed through the hole. 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. There is also a small risk of infection at the surgical site. Superpath total hip replacement animation. It's a hip replacement surgery where you lie on your side. out the next afternoon and using a walking stick from day 2 to day 10 when I ditched it altogether . 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. I prefer spinal anesthesia when possible because fewer drugs are used and often the experience is gentler. They thought it would give me about 5 yrs. 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. Im not sure why you developed a problem with your IT band. Which approach did the doctor take? I had no inkling of this till he showed me on the x-ray. 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. Clearly, he or she has earned your respect and confidence. Did you have the surgery via Superpath method? It is critical at time of surgery that an excellent range of motion be created without impingement. Many studies suggest that any limp or clinical weakness resolves after approximately three months. Infection. Hip Replacement Surgery & Recovery | University of Utah Health Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. I was released to go back to work after only 10 days. What is SuperPath Hip Replacement? I ski, hike (steep terrain) with a pack -about 25 pds, kayak, horse back ride, swim, water ski and bike, which is getting increasingly more difficult. Egton Medical Information Systems Limited. How does it affect the actual success of the This can be dangerous because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. I prefer reconstructing the most symptomatic side first. Dr. Himmelwright Introduces SuperPath to OIP An anterior capsule is the only soft tissue cut during this procedure to insert the implants. Above the ankle to the thigh.Had to use leg brace to Many of these stems have very little if any long term follow-up, although some appear to be doing well in the short term. Patients can also have as little as a 3-inch incision. Risks of SUPERPATH hip replacement surgery Risks due to the surgery may include (but are not limited to): Pain Bleeding Infection Permanent or temporary nerve damage Extra bone or tissue damage Drop in blood pressure during the procedure Leg deformity Blood clot or clots (that could travel to heart or lungs) Delayed wound healing DAA and SuperPATH were equal in functional outcome and acetabular cup positioning.