I had posterior and much like the superpath trussed into the jig . I really dont know where to go from here. There are a few complications that can occur with anterior hip replacement surgery. I am 63 years old, 54, 115 pounds. 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. No, I would not tolerate the pain and immobility, if there is a reasonable way to relieve it. That's all I know. Use of the forums is subject to our Terms of Use Notes on SuperPath experiences good or bad, https://patient.info/forums/discuss/superpath-experiences-good-or-bad-718788. 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. I had a consult with a surgeon who does posterior and cuts muscle & tendons. 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. After reading your article on disadvantages of anterior approach and also doing extensive online search about this subject, I came to realize that anterior approach was definitely a wrong choice considering my physical build short, muscular, overweight. Dear Jo Anna, 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. This is not true for bilateral cases. There is a chance that the hip will fall out of the socket, or that it will be levered out by twisting it. Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. I advise both my total hip and my total knee patients to avoid repetitive impact activities like distance running. I assume its something near my groin. Long-term outcomes of SuperPATH approach need to be investigated. I have had to modify my activity level by cutting back greatly and also trying new activities that might not strain my hips so much(tried water walking in the deep end which cause deep pain for 2-3 days afterwards). Do you agree? 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). It is normal to want to recover quickly and return to a very active lifestyle without pain. You are free to opt out any time or opt in for other cookies to get a better experience. General comments will be answered in as timely a manner as possible. Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. Click to enable/disable Google Analytics tracking. 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. The posterior approach, then, is less inherently stable but may or may not require precautions. In the right hands, both approaches do great. Posterior hip surgery may be the best option if your surgeon makes a larger incision at the side or back of the hip joint. I often suggest to my patients that they speak to other patients for whom Ive cared and to whom they can relate to learn about their experiences. What, if anything, can be done to revive femoral nerve and get my thigh muscles back in normal? Depending on the degree of injury, you may need a knee brace to lock you knee in extension when walking until the quad function returns. Many, many interactions and decisions go into the final result as well as someones perception of his or her result and experience. 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 second advantage of a small incision is that it makes it easier to clean and care for the hip. Also, if a surgeon knows in advance that a certain range of motion is desired, can they provide some adjustment in surgery to help accommodate that desired movement? It would be interesting to hear what you have to say Doug. It was also observed to be associated with longer surgery times. Clearly, yours was. respect of any healthcare matters. The doctor is planning a traditional posterior. The first is that it is a major surgery, so there is a risk of complications such as infection. The nerve which supplies sensation to the front and side of the thigh is vulnerable. Its interesting that when we critically analyze all the variables that ultimately make up the experience that one person has compared with another, or that one person experiences on one side versus the other, we come to recognize its not so straightforward. I suspect there is significant underlying osteoarthritis related to your labral pathology. The technique allows recovery that is as rapid as a mini-posterior approach while conferring stability of the hip joint that is equal to other exposures that . 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. I dont think there is one best prosthetic. Some have features that are more suited to one persons anatomy and needs than others. We now have too many other proven bearing surfaces available. I believe choosing your physician is the most important decision you can make. Lastly, where can I find a great surgeon that takes FL Workmans Comp? A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). Ive come to the conclusion that perceived benefits do not outweigh the risks with the anterior approach, especially when I can achieve the same or more using the mini-posterior. Thank you. If possible and a pool available, I encourage my patients to walk and exercise in a pool and / or swim, starting at two weeks when their suture is removed. In the dark to find out about this myself. I then would strongly suggest you trust that person to decide what approach and what prosthesis predictably will deliver the best results. Also, is it immoral for an 80 year old to have THR and cost the nations health care system $25 $35k? 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. The mini posterior approach works wonderfully and predictably when expertly performed. Fax: 954-489-4584 (I have SCD) It has now become unbearable and I am preparing for surgery. An anterior-approach hip replacement necessitates a small incision in the groin area on the front side of the leg. So frustrating. July played my last match when I buckled. Celle said: Superpath may give you a faster early recovery, but whatever method is used, recovery is still going to take a long time. 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. as being in breach of those terms. The size and placement of the incisions will be different. My physical life is diminished. I'm hoping to read some posts post surgery. Always speak to your doctor before acting and in cases of emergency seek I weigh 185 and am 54 and realize its ideal to lose weight prior to surgery (working on it as always). There are a few disadvantages to hip replacement surgery. Simply, we keep trying to get better. I deal with major nerve damage on front of thigh, almost whole thigh. Also, I am diabetic and have had two organ transplants and am extremely worried about infections, etc. I choose to do them in a staged fashion because it is a significantly shorter procedure (more than half time-wise) and some think this lessens the risk of infection. No Muscles Cut is for billboards. Walking is the best exercise. Extensive release of the posterior capsule including . The hip joint needs to be replaced again when it no longer works properly because of a revision surgery. I understand that most surgeons now do a spinal rather than general anesthesia. Just getting your thoughts I will discuss it more with my surgeon at the pre-op meeting. Please comment. I seem to be able to hike just fine up hill and down but not always on the flat. No specifics were given to me from the orthopedist . Technologies, The Leone Center Does the mini posterior hip replacement conserve more femur and allow for future surgeries if needed ? You can resume your active lifestyle as soon as possible thanks to a new prosthetic hip. Again, considering my own practice, I routinely see my patients recover faster and easier after their second hip or knee replacement because they are more confident having had a good first experience. I am a 55 year old with a labral tear and moderate arthritis. By far the most important variable is the doctor who is doing your surgery and managing your post-op care. Dr. William Leone. Even a task as simple as putting on socks and shoes can result in debilitating discomfort when a severely damaged or arthritic hip is involved. I definitely didnt have any tendons or muscle cut and was cycling on the road from day 12 and back running at week 4 . If you are minimally handicapped with discomfort from the non-operated hip and the leg length difference is tolerable or easily managed with a shoe lift or modification, I would consider waiting. It was discovered that I had a torn Labrum. Even after the procedure is completed and the patient is on pain medications, pain and discomfort may occur in some cases. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. A couple of things I am hoping you will explain using laymans termology. It is important that these medical and cardiac conditions be optimized by your PCP and cardiologist preoperatively. 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. Infection. I play in the 50s age group. I never seem to know when I am going to get hit with pain. It seems, however, that at this time point, patients who have received resurfacings do as well or better than similar patients who have received total hip replacements. Dont let PR marketing confuse the big picture. Im sorry to hear that you struggled after your first, anterior-approach THR. Cant afford a dislocation or other complications cause Im sole caregiver for severely handicapped son. I think they are happier and rehab more quickly. 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. Why would the doctor not have that at their finger tips? If theyre really happy and got well quickly, you probably will too. 2 x week. So im going back to the surgeon that did my left hip and left me in agonizing pain for 2 months after procedure. I prefer reconstructing the most symptomatic side first. Comments about life-long hip restrictions between Posterior, Anteriorlateral and Anterior approaches? Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? My clinical impression is that more patients experience some degree of residual groin discomfort or tightness after the anterior approach as compared to the posterior approach, but that it tends to resolve with time. The anterolateral approach or Watson Jones approach is one of the classical hip approaches that can produce excellent results when utilized for THR. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. It is 100 percent normal and expected to be scared before surgery. Registered in England and Wales. Sitting seems to irritate it the most. An anterior capsule is the only soft tissue cut during this procedure to insert the implants. I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. Have you heard of something like this, and if so, is it worth it? I wish you a full and speedy recovery. 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? In May of 2015, I had a Labial tear repaired. So my question is in relation to my body structure. Woke up with Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. Most of the restrictions are removed at that time, although I still advise common sense, particularly for the first three or four months. After reading your blog Im thankful he suggested this approach. In my last blog post, I discussed minimally invasive surgery with regard to hip replacement. 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. The surgeon I expect to use does the Direct Anterior approach. Typically, most are eager to go home the very next day; many have already progressed to a cane, which they will not use very long. 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. There are various ways of doing a hip replacement. Finally, many people who are struggling with hip disease experience lower back pain or even sciatic discomfort. The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. I think seeing several surgeons for different opinions is good judgment. Hip replacement surgery can open up a world of possibilities for people who have lived with pain and restricted movement. About this injury to me. I, too, am struggling which approach to have. I did have numerous blood tests, MRI of knee and hip, total body scan with radio active injection, X-ray knee and hip etc. Dear Dr. Leone, I am having Makoplasty ( robotic imaging) to my right hip in February. This too will lower your anxiety and improve your experience. Complications Following anterior hip replacement surgery, avoid soaking in hot tub, sauna, or swimming pool immediately after surgery. I would encourage you to discuss your expected recuperation time and specific restrictions with your surgeon. I dont think one surgical approach is better or worse than the other for you to accomplish this. I'm so encouraged to hear your successful story. I believe a THR will benefit you tremendously. I think speaking to a patient with whom you can relate and who has been treated by the physician youre considering also is invaluable. By 2016 and over 300 SuperPATH cases, the results of very first 100 SuperPATH surgeries (the so called 'learning Curve') were published in a peer reviewed journal with . 2. Some people may find that traditional hip replacement surgery is the best option for them, while others may prefer a minimally invasive procedure. I ask my patients to restrict certain positions that exceed the mechanical limits of the artificial hip for the first six weeks. I do not do hip arthroscopy. Following surgery, the surgeon will devise a routine for the patient to engage in that is both comfortable and safe. Long recovery but all is well. We now have less-invasive techniques, better surgical methods of closing soft the tissue and more experience. The chances of developing a revision surgery after a posterior hip replacement are low, but you should keep all follow-up appointments with your surgeon and inquire when you can resume activities that go beyond 90 degrees or bend down to pick up something small after your procedure. When the capsule is fully healed, it forms strong ligaments that will eventually regrow (it will take about 4 months for the capsule to form again). We have to get ok from cardiologist and get ekg, chest xray, etc. Overall, it sounds as if youve had an excellent result and wonderful recovery following your hip replacement. Gary. Thank you, Lisa. What is most important is choosing your surgeon. Many wonderful physicians are part of various HMO panels. This means you could go home within 23 hours after surgery. Over the last decade total hip replacements have been performed using 2 main approaches: The posterior approach in which the hip joint is approached from the back by releasing and reflecting the short external rotators and dividing the capsule at the back of the hip; and the anterolateral . Should I be though? Blood clots or bleeding. Call (919) 781-5600 to find out if you need total shoulder replacement in Raleigh, Cary, North Raleigh, Garner, or Holly Springs. Surgical Techniques I am deciding that my quality of life is in the toilet and need to get the THR done. My acyive 60 year old husband is scheduled to have Mini posterior total hip replacement in 6 weeks. This is used when the cartilage in the hip is severely damaged by osteoarthritis or other conditions. Complications from infection account for approximately 10% of all cases. General comments will be answered in as timely a manner as possible, Hip & Knee Surgery You should consult with your doctor before deciding to have an anterior total hip replacement. Once it exceeds this ROM, impingement occurs. As a result of anterior hip surgery, there is little need for any special care. We thank you for your readership. Thank you. Additionally, there is a small risk of dislocation after surgery, which can be painful and may require additional surgery to correct. Driving hurts too. It is critical to make the right decision regarding anterior hip replacement surgery in each case. Personally, it I were caring for you, I would have advised you exactly as the orthopedic surgeon who took care of you did. I think its always beneficial to speak to other patients who have been cared for by that physician and learn about their experiences and results. It normally takes about 3-6 weeks to resume normal household activities and about 12 weeks to resume recreational activities like bicycling or golfing. 2012 Oct 17;94(20):1897-905. doi: 10.2106/JBJS.K . Choose your surgeon. In 2014 I had to do another THA, this time on my right side. There arent any activities that you can do with a resurfaced hip that you cant do with a total hip. Im so pleased to learn that you had a good experience. 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. Historically in my practice I performed many Bilateral THR and TKR and have backed away from that practice. The actual length of the incision really is not important, but rather how well the components were implanted and the hip mechanics restored. Though the duration of your hospital stay can vary, many patients having hip replacement surgery don't need to stay in the hospital very long. I suggest you discuss your concerns with your surgeon. Im pleased that you will be coming in for an appointment. I am experiencing pai. I worry that replacing it with a differently configured socket could make things worse rather than helping. Hi Frances, did you have surgery posterior Superpath? We can help you make the best decision for your knee replacement, and our friendly staff is available to answer any questions you may have. Thank you very much for taking time to reply me. If you do not have a hip replacement, you will live a sedentary lifestyle and become overweight. As a result, you are unable to pick up something from the floor or bend down to tie your shoes. Risks of Hip Replacement Surgery The major risks include the following: Blood clot: We do reduce risk of this by using blood thinners (Enoxaparin, Aspirin or Coumadin), TED hose (compressive stockings) and compression boots on your feet to increase circulation. 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. Very slow recovery. There are numerous complications associated with hip replacement surgery, but blood clots in the legs and hips are two of them. Try our Symptom Checker Got any other symptoms? Overall, however, anterior hip replacement is a safe and effective procedure with a high success rate. I wish you a full recovery. Thanks. I think the money you spend to have a hip replacement is more than just moral or justified, it is smart business. After all, no matter the age, it will determine the likelihood of maintaining your mobility and independence. Full Function, Faster . How does it affect the actual success of the Historically short press fit stems have not done well. The approach planned is a frequent topic of Continued If its a struggle, then the situation needs to be reassessed. Do you have any advice or ballroom dancer THR stories to share? My husband has a plastic valve (done in 86) and synthetic assending aorta and triple bypass (done in 2013)very successful surgery. These stems are a new design, and therefore do not have an established track record. I would avoid the metal-on-metal articulation. I had an anterior approach hip replacement. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. I am scheduled for bilateral hip replacement at the end of August. emergent norm theory quizlet. Also, when a single joint is replaced versus bilateral, there is significantly less bleeding and hence a much decreased need for transfusion. It is possible that you will be required to avoid certain high-impact activities to protect your new hip. not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in The mini-posterior is considered a more straightforward approach then the anterior, resulting in lesser complication rates. This complete wall of tissue that surrounds the new hip imparts stability. Can you explain it to me as he didnt go into detail. He treats a variety of hip, knee, and shoulder conditions, and performs hip and knee total joint replacements. The anterior approach is not as muscle sparing as some would argue. But I am now in chronic low grade pain thats getting worse and dont know what I should do. It exploits the inter-muscular interval between the tensor fascia lata and the gluteus medius. 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 is less blood loss with a single THR than a bilateral, hence less risk of needing a transfusion. Recognize that the underlying etiology is not being corrected by this procedure, so relief of symptoms probably will be temporary and possibly partial. 4. Thank you. That said, in general people who are longer, more flexible and thin are more easily constructed anteriorly than individuals who are very stiff, contracted, thick, and have acetubular protrusion (a condition when the femoral head wears away the central cartilage and bone of the acetabulum). Update what hes cutting is the adductor so my question is the same is this just a normal part of some THRs? Im sorry to learn that you are so disappointed with your hip replacement. I have seen a number of patients who were reconstructed with the anterior approach who developed painful anterior scarring after the procedure. Both have valid cons against the others methods and pros on their method. A orthopedic surgeon may insert a numbing agent directly into a new joint, which can last up to 48 hours. It sounds as if you had a wonderful surgeon. Im ready to have the surgery, having been basically bone on bone for several years. Hard-on-hard bearings, such as ceramic-on-ceramic as well as metalon-metal articulations, also resulted in larger femoral heads being implanted. I would not recommend pushing your surgeon to use one specific approach or another. Regardless, the overall incidence of dislocation for every approach is smaller due to use of larger femoral heads and enhanced closure techniques. I will let you in on something personal. 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). These can include damage to blood vessels or nerves, dislocation of the hip, and infection. It's cut off and removed through the hole. If was 3 weeks after discharge What is your experience and take on this ? I am planning to have a THR this summer. The SUPERPATHTM procedure provides a number of advantages over traditional hip replacement surgery. 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. THR if a MRI or Pet Scan isnt done? Risks associated with hip replacement surgery can include: Blood clots. 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. The incision made for the operation can be as small as three inches. I live in Staten Island and need rt hip replacement. We can do this because of improved plastics. My surgeon does the SuperPath method. 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. [QxMD MEDLINE Link]. I have done everything I can think of to preserve my right hip, but sadly this too needs replacing. I think there may be increased associated complications. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. Many times, the depth of the destruction that is found during surgery is much more advanced than initially anticipated, particularly as we age. Sometimes the pain goes away as I walk and sometimes it doesnt. The impingement can be between the metal neck of the stem and edge of the cup or between soft tissues. I have had both hips replaced about 13 months apart, one anterior and one posterior, and there is no doubt that I would recommend anterior. My second question relates to something you mentioned earlier regarding checking the published track record of the surgical team if I use an HMO, how do I find that information, and how do I know it hasnt been skewed to give more favorable results (lying with statistics)? The amount of PT you need after surgery will be determined by you and your surgeon. Since 1995, there has been an extremely low dislocation rate and an infection rate of zero percent. 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. Do you have any thoughts on this issue? 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 doctor used the posterior procedure. A hip replacement is an excellent option for people who suffer from significant pain and disability as a result of arthritis in the hip joint. Tossed the cane at three weeks and went back to work. Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. Also, the surgeon said that I would end up having one leg shorter than the other is this true? I wish you only the best, Ceramic-on-polyethylene is currently the most popular hip replacement material, representing 50.6% of all hip replacement cases back in 2014. Hello Dr. I have/had arthritis in my hips. This treatment is commonly recommended for patients suffering from osteoarthritis of the hip. I have never operated on another surgeon who asked me to make as small an incision as possible or use the minimally invasive approach. I also think infection must be investigated and ruled out. Hip replacement via SuperPATH approach had a longer operation time than hip replacement via conventional approaches. Spring 2014 had trouble playing tennis, hip kept feeling like it was popping out of joint, groin pain, aching. I would stay away from narcotics. This suggests that something changed after five months. United States. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. Fortunately you live in a part of the world where there are many capable orthopedic surgeons.
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