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. There always are conditions or circumstances that may predispose one to limp or feel as if their legs are not the same length after surgery, but in my experience this is the exception. I prefer spinal anesthesia when possible because fewer drugs are used and often the experience is gentler. I wish you well. Can I make an appointment with you. 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. Lateral femoral cutaneous nerve injury is the most common injury incurred during an anterior approach. Most of my patients now go home the day after their surgery or the next. Thigh feels so Heavy and I massage that area a lot. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. I am not sure that is true any more. Extensive release of the posterior capsule including . What reasons would there be to use the regular over the mini? There has been an increase in the range of motion. 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. This too will lower your anxiety and improve your experience. How do you ask your doctor the questions you want to ask? This does not necessarily mean they will have more pain or take longer to get well. Both have valid cons against the others methods and pros on their method. While new techniques, instruments and prostheses have been developed specifically for minimally invasive surgeries, there are many well-established approaches to hip replacement. Reconstructing the opposite hip hopefully will result in legs that feel more equal. I am 63 years old, 54, 115 pounds. It is also possible to have an anterior hip replacement during pregnancy. I think it perfectly ok to discuss different approaches and ask for an opinion. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. All have advantages and disadvantages. Because of this, when you're ready to get up and walk about again, engaging your muscles and hip flexors might be extremely tough. The second advantage of a small incision is that it makes it easier to clean and care for the hip. I think it is important to define and isolate why youre doing so poorly. Losing weight and strengthening your muscles pre-operatively will make surgery easier and greatly facilitate your rehab. You can be successful by staying healthy by sticking to less pain. Brian Tinsley. It will help desensitize and help get your muscles working in synchrony. Ill be 60 at the time and Im 54 and weight about 130 lbs in fairly good shape. Please comment. We are now in a situation where we have found two extremely good surgeons and we gel with both extremely well. Because the dissection is over the front of the hip, a number of patients will experience residual pain and tightness anteriorly (in the front of the hip) at least early on. The incision made for the operation can be as small as three inches. Prior to surgery, you need to be evaluated by your primary care doctor and any other specialist who helps manage your care, so the conditions you have can be optimized. That I knew this recovery may take 1-2 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. There are a number of different potential surgical approaches available for hip replacement, each with their own potential advantages and potential drawbacks. How the soft tissues are handled and respected, the patients expectations before the surgery and the surgeons experience do. Each approach you list has advantages and disadvantages. So my concerns include having the range of motion to perform moves like promenade where my body is roughly facing forward and my right leg will take a step left across my body at about 90 degrees. Mini posterior refers to the approach or tissue interval the surgeon uses to implant the Total Hip. The bone isn't dislocated in surgery. About this injury to me. This risk is greatest in older females with bone of sub-optimal quality. Will I still be able to do all of these things? I suspect there is significant underlying osteoarthritis related to your labral pathology. There are potential drawbacks to anterior hip replacement. Many of these stems have very little if any long term follow-up, although some appear to be doing well in the short term. Changes will take effect once you reload the page. That being said, I agree completely with your surgeons advice to have a total hip replacement and not a hip resurfacing. Finally, in July 2013, the first SuperPATH Hip replacement in Australia was performed in Nepean Private Hospital, Sydney. If I can put you on the spot. I am looking at how many hips they have done and where they are doing them. Do you agree? You should avoid sitting in low chairs, beds, or toilets. Sometimes, it simply isnt possible to accomplish. I dont want a long recovery time as I am very active. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. The art of surgery should mimic a well rehearsed ballet or symphony. Long-term outcomes of SuperPATH approach need to be investigated. This robotic technique can assist in producing an excellent result. Many wonderful physicians are part of various HMO panels. Thanks for giving us patients the kind of information we need to be more educated as to what questions to ask. The impingement can be between the metal neck of the stem and edge of the cup or between soft tissues. I would rather this not happen with my right leg when I have the THR in Jan 2017. Would not make eye contact. You can check these in your browser security settings. It all comes down to the surgeons comfort as well as the patients. Patients can also have as little as a 3-inch incision. The best of luck to you, You can also change some of your preferences. I, too, am struggling which approach to have. In general, if someone is dedicated to the job, the return is very quick. 35 (2):153-62. Diagnosed possible labral tear. Conserves the two main muscles that make up the front of the hip and upper thigh aspirated via the direct anterior approach. I have linked back to several blog posts below that will give you more in-depth information. He also used the term anterolateral. Thank you so much for taking the time to inform us! 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. When done well, your body does well with this technology. Celle said: Superpath may give you a faster early recovery, but whatever method is used, recovery is still going to take a long time. Both of these are very successful ways of doing a hip replacement. No i just had the posterior method which has a larger incision. Personally, I would not gamble with my health. I dont know what happens on that tablewas he in a hurry on Friday afternoon. Traditional hip replacement surgery is no longer an option, but it is less painful and has a number of advantages. Im so pleased to learn that you had a good experience. Click on the different category headings to find out more. Patients who are significantly overweight (I specifically assess the amount of tissue between the skin overlying the lateral hip and the greater trochanter), who have significant long-standing contractures and restricted ROM, congenital dislocation, and marked acetabular protrusion (when the femoral head wears centrally into the acetabulum) typically require a larger incision and more soft tissue releases. #1. I was really careful bending etc for four weeks until I saw the physio, who said "oh you could have touched your toes if you had wanted to!" Had arthroscopy in Jan 15, cleaned up tear and arthritis. Hip replacement is the second most common type of joint replacement, trailing only total knee replacement. Even if the hip doesnt dislocate, prosthetic or soft tissue impingement is not beneficial. I believe choosing your physician is the most important decision you can make. Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. The bone isn't dislocated in surgery. How would a hip replacement be done? It is important to understand that "less invasive" does not only refer to the incision but . I have a tilted sacrum, sway back and a very large posterior. Would appreciate any input you might have on the auto immune issue, and weight etc. Less tissue damage during surgery allows for a much faster recovery and no restrictions in range of motion when compared to traditional hip surgery. The risk of revision surgery after a posterior hip replacement is the most serious concern. Many patients approach this by researching online and speaking to other patients who have been cared for at a particular facility. 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. Total hip replacement is one of the most successful operations ever developed and is a remarkably predictable way to relieve pain from arthritic conditions. 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. These cookies collect information that is used either in aggregate form to help us understand how our website is being used or how effective our marketing campaigns are, or to help us customize our website and application for you in order to enhance your experience. I had a posterior, the surgeon did not cut any muscle, they just move them now. I wish you the best of luck, The doctor has scheduled me for total hip replacement in two weeks and he uses the Posterior approach, he didnt say anything about the mini part. Consuming excessive-fibre and wholegrain meals will assist to keep you feeling full, and will be They thought it would give me about 5 yrs. I just want to thank you for the information on this site. 4 mts later am using 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. And does A really have none. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. I have not seen this before because in the past, the complication from hip surgery were sciatic nerve injury from posterior approach. Doc says once recovered I should avoid flexion with adduction and internal rotation. Each approach has advantages and disadvantages. I did have numerous blood tests, MRI of knee and hip, total body scan with radio active injection, X-ray knee and hip etc. Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? I am so sorry to learn that you have had such a bad experience after THR. Since 1995, there has been an extremely low dislocation rate and an infection rate of zero percent. Fax: 954-489-4584 Therapy is often appropriate for stretching, strengthening and electrical stimulation which helps maintain the motor end plates, structures on the muscles that the nerve branches must re-innervate. What to Expect A neurologic evaluation is appropriate to rule out reversible causes, but most work-ups do not elicit the exact etiology and usually symptoms only can be managed at best. Because of the straightforward exposure of the femur, there is less risk of femoral fracture or poor implant positioning. Technologies, The Leone Center Had a total hip replacement aug 2013. I read about this type of mini hip replacement being done in the UK and just wondering if mini hip replacement means the same thing in the US . Publications I would avoid the metal-on-metal articulation. 4. Also I have read that there is a sharp learning curve that must take place in order to do the direct anterior approach. 3 years ago, 2012 Oct 17;94(20):1897-905. doi: 10.2106/JBJS.K . It is important to consider the SuperpathTM technique if you are considering a hip replacement. It normally takes about 3-6 weeks to resume normal household activities and about 12 weeks to resume recreational activities like bicycling or golfing. 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. Woke up with Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. The socket of the pelvis is machined into a hemisphere and a metal hemisphere is inserted into the socket. For example, the stability of the components could have been achieved initially, but then proved inadequate so you developed either a loose cup and/or a loose stem. The surgical "approach" in total hip replacement describes the anatomical pathway and technique that the surgeon uses to access the hip joint to perform the surgery. Not only was my recovery twice as fast with the anterior, there was very little pain in comparison. What are your thoughts with regard to Stem cell therapy in lieu of THR? Start your day off right, with a Dayspring Coffee Hip replacement is a fantastic operation that can help relieve pain, improve daily function, and improve quality of life. I also regularly receive Rolfing treatments which has helped me manage pain and maintain what mobility I have. I am totally confused and dont know which procedure to choose. 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. Even after the procedure is completed and the patient is on pain medications, pain and discomfort may occur in some cases. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. When the anterior approach is used, the soft tissues in the hip stay intact, allowing for better hip alignment. You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. I deal with major nerve damage on front of thigh, almost whole thigh. I have dealt with my hip pain and limping for over a year, can no longer perform my daily activities, and cannot sleep well anymore. Once it exceeds this ROM, impingement occurs. emergent norm theory quizlet. Testimonials Recovery time for anterior hip replacement is typically two to four months, and recovery time for posterior hip replacement is typically four to eight weeks. Just because hardware in your foot needed to be removed after repairing what sounds like a calcaneal (heel) fracture, absolutely does not mean that your body rejected the metal / hardware or that your body will reject the prosthesis your surgeon will implant to reconstruct your hip. I would say that in terms of posterior total hip replacement, the procedure is better than the old gold standard, which I believe was performed after 7 years and almost 1000 anterior total hips. You should feel good that you are aware of your fears and that it hasnt paralyzed you into not acting. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. Surgical approach is important but its just one of many important variables. Currently, the incidence of dislocation after the posterior approach has been greatly reduced due to technique and other refinements. According to Dr. Rosen, the most important thing to remember is what you leave behind rather than how you get there. 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? My main concern is that I have a tilted sacrum and a very sway back. All orthopaedic surgery demands a long recovery period. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. 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. Can you explain this approach? United States. Clearly, he or she has earned your respect and confidence. This site uses cookies. Getting in and out of cars, and turning over in bed. I wish your patient well. There are 5 questions, mobility, self-care, usual activities, pain and anxiety. The intended interval between the front thigh muscles can be difficult to recognize and there has been an associated increase in injury to the femoral nerve or vessels. Until now. If possible, try to get in writing any verbal promises made. I am now bracing myself for THR surgery within the next year and am wondering if there is any big advantage in trying to have this done by a surgeon who offers the customised implant, as above. Lazaru P, Marintschev I. I think the recovery time is the same though. Granted I do deal with lower back OA and right knee OA and now all worse and now foot/ankle mess, all on right hip side. 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). Sitting seems to irritate it the most. From what Ive seen, most THR patients dont need very much PT, although I do encourage exercising in a pool. 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. There are many benefits to posterior hip replacement surgery including a quicker return to daily activities, a more natural feeling hip joint, and a decreased risk of dislocation. 2023 Brandon Orthopedics | All Right Reserved, hip replacement pain reduction surgery patients, The Best Sneakers For Hip Replacement Patients, Anterior Hip Replacement Surgery: The Pros And Cons, The Truth About Spinal Stenosis: Causes Symptoms And Treatments, Can Years Of Surfing Contribute To Spinal Stenosis, The Effects Of Spinal Stenosis And Carpal Tunnel, Should I Apply Ice Or Heat To A Compression Fracture, How Does A Soft Bed Prevent Healing Of Herniated Disc, Herniated Discs: How To Sleep Without Worrying About Rupturing Your Discs, If You Have A Herniated Disc You Know The Excruciating Pain It Can Cause. 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. Some patients report that symptoms increase in the not-yet reconstructed hip because of the leg length inequality. Overall, it sounds as if youve had an excellent result and wonderful recovery following your hip replacement. not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in It is also important to avoid any sudden movements or twisting motions. I assume its something near my groin. Help. I, personally, have not had a patient dislocate following a primary total hip replacement in many years. Is a prerequisite for THR to have a MRI or Pet Scan? That's all I know. I encourage you to do the same. I would suggest seeking out doctors who specialize in hip replacement surgery rather than general orthopedics. I am scheduled for bilateral hip replacement at the end of August. 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. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. Hip replacement surgery can open up a world of possibilities for people who have lived with pain and restricted movement. My surgeon does the SuperPath method. I would also like to know about the customized implant, as I havent yet heard much about it. In my last blog post, I discussed minimally invasive surgery with regard to hip replacement. However disadvantages include the inability to adjust for leg length differences and a relatively high risk of femoral neck fracture. I had the mini-posterior at MGH hospital. A major hip replacement can take up to four months to fully recover from. SuperPath approach is the least invasive due in part to the minimal amount of tissue damage. Have you heard of something like this, and if so, is it worth it? I would rather my patient get half as much anesthesia. One advantage the ceramic-on-polyethylene carries is the lack of . Advantages of an anterior approach to hip replacement A major muscle is not cut during the anterior procedure. In a posterior hip replacement, the procedure is done on the side of the hip. 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.