[QxMD MEDLINE Link]. When people loose independence and mobility, not only does the quality of life suffer, they are much more likely to develop a myriad of medical problems requiring even more-expensive and/or long-term care, including loss of independent living. Hip replacement surgery is less painful than arthritis or fracture-related pain. A hip replacement with an anterior component does not require major muscle cuts and thus patients are less likely to experience pain and require less medication. Orthop Clin North Am. This improved quality of life will be beneficial. The hip joint can be supported by the socket, which is designed to fit over the ball and provide stability. Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. Hard-on-hard bearings, such as ceramic-on-ceramic as well as metalon-metal articulations, also resulted in larger femoral heads being implanted. The best of luck to you, Today, everything from tools to techniques has improved. 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). He is well known as a top doc for 20 yrs & I was persuaded because the mini posterior has less chance of nerve damage & the surgeon has more options for types of spikes, which your article explains well. Finally, because my patients are walking the day of surgery, most want to go home rather than to rehab. Please do not take this as an attack, but your article seems biased on your experience (great results with min. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. DAA had a lower rate of hospitalization and functional rehabilitation as compared to the lateral approach, as well as a lower perceived level of pain. I seem to be able to hike just fine up hill and down but not always on the flat. I also think infection must be investigated and ruled out. The actual length of the incision really is not important, but rather how well the components were implanted and the hip mechanics restored. Full Function, Faster . What are your thoughts with regard to Stem cell therapy in lieu of THR? Thank you for sharing with others the nerve supplements that youre finding affective. I have done everything I can think of to preserve my right hip, but sadly this too needs replacing. The pain in my hip is strange in that I can hike uphill and down hill, bike and X-country ski but have a very hard time walking on the flat, especially after sitting for awhile or getting out of bed. It is also possible to have an anterior hip replacement during pregnancy. The other things that can affect the op is your fitness beforehand, your attitude and your age, although you may have difficulty getting younger!! Hip implants are medical devices intended to restore mobility and relieve pain usually associated with arthritis and other hip diseases or injuries. I am just under 5 ft and weigh 185. hi im following as im due a superpath soon, there is no one size fits all everyones different I've had 2 hip replacements in 2 yrs one in 2017 then a revision to change the ball and socket to the smallest one they had and now I'm going for a smaller stem I had the anterior approch done which is in the front which is way better then the posterior as the front they can just move ur muscles over to the side to accsess ur hip rather then go through the back or side where they have to cut the muscles. Risks associated with hip replacement surgery can include: Blood clots. Tina, which procedure did you have? as being in breach of those terms. However, there are also some potential drawbacks to this type of surgery including a longer surgery time, a greater risk of blood loss, and a higher risk of nerve injury. Some in the early period have good track records, others do not. Most activities of daily living have an element of hip flexion (knee up to head), which is a safe position after the anterior total hip. These scores are not aggregated. I weigh 185 and am 54 and realize its ideal to lose weight prior to surgery (working on it as always). July 2013 my left hip was scoped for a labral repair. In 2013 I had a THA done on the left hip. Patients who work for themselves are very motivated to return to work and often do so between procedures. While it is a surgery that does help many, many people, clearly you are struggling. Hip replacement surgeries are becoming increasingly popular due to their numerous benefits, such as increased range of motion, reduced pain and disability, improved mobility during pregnancy, and improved quality of life. I try not to bring up my mess but its hard when its with one 24/7. Over the years, these precautions and the length of time to adhere to these limits have been challenged both by clinicians and patients. 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. William Leone. The first step to rule out infection is to have two simple blood studies done, an ESR and CRP. Upgrade to Patient Pro Medical Professional? Thanks. If these values are elevated, further investigation with hip aspiration should be considered. Im so pleased to learn that you had a good experience. I am concerned that I may have a pinched nerve and that that is what is causing all this pai as the pain is severe only in certain positions but when I am tired I also have a throbbing pain in the sciatic region.talk about the golden yearsI thank you from the bottom of my heart for the kindness and caring that you do in answering all these questions. I do participate in competitions and showcase presentations. That being said, I agree completely with your surgeons advice to have a total hip replacement and not a hip resurfacing. Intervals between muscles are separated or muscles are separated in line with their fibers without injuring the muscles innervation. I believe choosing your physician is the most important decision you can make. The femoral prosthesis is inserted into the hollow part of the femoral shaft. The SUPERPATH technique is a tissue-sparing procedure which aims to get patients back on their feet within days (possibly hours) instead of weeks or months. I still have some questions I hope you can answer as this is so distressful for me. 1. Comparison of short-term outcomes between direct anterior approach (DAA) and SuperPATH in total hip replacement: a systematic review and network meta-analysis of randomized controlled trials. I will need the other hip done within the next 6 months, and despite all the talk of the anterior approach- I can use myself as the best judge to the best method. Because visualizing the femur is easier, an experienced surgeon can choose the most appropriate femoral implant rather than just the one that is easiest to implant, taking into account the patients bone quality, activity level and age. I have never operated on another surgeon who asked me to make as small an incision as possible or use the minimally invasive approach. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. Doc says once recovered I should avoid flexion with adduction and internal rotation. emergent norm theory quizlet. Many times, the depth of the destruction that is found during surgery is much more advanced than initially anticipated, particularly as we age. Your article is the first Ive read in which no muscle or tendons are cut in any approach other than the direct anterior approach. Sometimes, it simply isnt possible to accomplish. 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. Hip replacement surgery is typically performed in a hospital and requires at least one night in the operating room. Thru X-rays Ive been told both hips are bone on bone! Most patients decide not to wait as long to have their contralateral hips or knees replaced after having undergone a successful surgery on the first side. It is important to consider the SuperpathTM technique if you are considering a hip replacement. What are your thoughts on the use of robotics? It sounds as if you had a wonderful surgeon. THOUGHTS? I prefer reconstructing the most symptomatic side first. In the case of a worn or damaged ball and socket, artificial parts can be used to restore joint function. It is nice to see honest Q&A versus a marketing page. Also, I am diabetic and have had two organ transplants and am extremely worried about infections, etc. Thanks, I am planning to have a THR this summer. You can resume your active lifestyle as soon as possible thanks to a new prosthetic hip. I emphasize continuing exercises at home especially walking. 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. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. The surgeon I went to said he does THR using a lateral approach. 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 I would not recommend pushing your surgeon to use one specific approach or another. The vascular supply of your leg must be assessed preoperatively as part of you work-up, but most do very well. I went with a total hip replacement. Im a very healthy long distance bicycle rider. That I knew this recovery may take 1-2 A metal or plastic implant is used to replace a damaged or diseased hipbone. Dr. William Leone. Part of those possibilities includes a better and more comfortable sex life. What is most important is that you find a surgeon who understands the particular complexities with your problem and whom you trust. Choose your surgeon. My surgeon uses the posterior approach. She never though mentioned an increased risk of damaging femoral cutaneous nerve or possible muscle damage that would turn into improperly heeled muscle as a result. When the anterior approach is used, the soft tissues in the hip stay intact, allowing for better hip alignment. 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. Because the anterior hip replacement surgery is a minimally invasive procedure, no cuts are made to the muscles surrounding the hip. I was thinking of doing that 1st, maybe April(Ill be in boot 4 weeks), and then the PTHR in either Sept or next Jan when I have free time. I wish you a full and satisfactory recovery. The posterior approach for hip replacement surgery is by far the most common surgical technique used in the United States and throughout the world. Because the mini-posterior is more straightforward, many surgeons think it provides an increased margin of safety for the patient, because the incision can easily be extended if exposure is poor, or if a fracture occurs. Registered in England and Wales.
The first is that it is a major surgery, so there is a risk of complications such as infection. The surgeon does about 200 a year and people say he has a good reputation. I have been told that I can fly 48 hours after surgery?? When it comes to hip replacement surgery, the surgeons skill, the patients weight and build, and the surgeons level of experience all have an impact. I am experiencing pai. The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. The most important variable is how quickly the person is motivated to return to work. Im getting close to needing my left hip done. 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 traditional posterior approach is the most commonly used in the United States and throughout the world (about 70 percent). Do you also do arthroscope surgery? I then would strongly suggest you trust that person to decide what approach and what prosthesis predictably will deliver the best results. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. disadvantages of superpath hip replacement. The hip is replaced without the need for surgery to dislocate the joint. Mayo Clinic researchers have studied ways to reduce blood loss, control pain and speed recovery for people who undergo hip replacement surgery. Its been six months since surgery, my operating doctor keeps feeding me with lets wait another month stuff. In the United States, a traditional posterior approach is the most commonly used. This too will lower your anxiety and improve your experience. Some other methods are effective, but they are less effective for patients who leave the hospital earlier. 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? I had the surgery on June 22 and I am about 5 weeks post op. Hospitsl staff I worry that replacing it with a differently configured socket could make things worse rather than helping. Unfortunately, injury to the lateral femoral cutaneous nerve is a common complication after the anterior approach for hip replacement. The vast majority of my patients have their surgeries with a simple spinal with IV sedation so they are sleeping throughout the procedure . What is SuperPath Hip Replacement? Also, when a single joint is replaced versus bilateral, there is significantly less bleeding and hence a much decreased need for transfusion. One thing I do not want is any muscles or tendons cut in the procedure. I wish you a full and uneventful recovery. There is a more than 200% chance of knee infection, most likely because the knee has more surfaces that can become infected with an infection. For many years, I performed bilateral THR and bilateral TKR procedures, but have backed away for a variety of reasons. The surgeon I expect to use does the Direct Anterior approach. Ann Transl Med. I have two questions one, how realistic would it be to try to have both hips done at the same time? 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. I was released to go back to work after only 10 days. 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. THR if a MRI or Pet Scan isnt done? Glad that after lots of PT and massage and medial branch block for back issues with NO!!! It was discovered that I had a torn Labrum. Thanks for giving us patients the kind of information we need to be more educated as to what questions to ask. I find that patients who are well informed and know what to expect prior to surgery get well even faster. When asking a prospective surgeon about the anterior vs posterior approach he told me that it is necessary to use a smaller prosthesis which would not be as stable with the anterior approach and did not recommend it for this reason. A hip replacement is the most common cause of complication in about 20% of cases. Im pleased that you will be coming in for an appointment. Over the last six years, I have performed more than 2000 primary or first-time total hip replacements using the mini-posterior approach and I am aware of only one patient who dislocated his hip because he fell down stairs. There is a chance that the hip will fall out of the socket, or that it will be levered out by twisting it. Cant afford a dislocation or other complications cause Im sole caregiver for severely handicapped son. All orthopaedic surgery demands a long recovery period. There is also a small risk of infection at the surgical site. Conclusions SuperPATH approach showed better results in decreasing incision length and early pain intensity as well as improvement of short-term functional outcome. The development of a complete and secure surrounding scar tissue wall or pseudo capsule is critical for stability. Also, is it immoral for an 80 year old to have THR and cost the nations health care system $25 $35k? Hey, thanks for the forum topic.Thanks Again. This treatment is much more definitive and predictable. Thank you for sharing. Felt very uninformed and left This is particularly true if the person is overweight, has very muscular thighs or is short. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. Finally, in July 2013, the first SuperPATH Hip replacement in Australia was performed in Nepean Private Hospital, Sydney. Thanks again! The majority of teaching institutions in the United States continue to instruct as well as perform the traditional posterior as their primary approach. That being said, if the foot is now a much bigger problem than the hip, you may have to deal with that first. Dear Dr. Leone, Most individuals who have had total hip replacement surgery fall into this category and simply resume their lives.. I would like your opinion on the stem cell injections as I am really afraid of the second surgery on the same side of my body. Over time, some patients may acquire sensitivity or an allergy to the metal particles produced by the metal ball and socket. 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. Click to enable/disable essential site cookies. Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. I also would encourage you to choose your surgeon first not the procedure, approach or prosthesis. In my experience, there is a faster and more-consistent recovery with the mini-posterior. My question is, what will my restrictions be? The most common type of total hip replacement is done in the anterior anterior part of the hip. The SUPERPATH hip replacement is a new technique using superior capsulotomy that allows for implantation of the total hip components under direct vision through a single incision. Its been 8 months now. Thank you for this great informative discussion. In my 25 years of practice, the variable that seems to have changed the most is how quickly people recover from this surgery when done well. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. I am not sure that is true any more. 2012 Oct 17;94(20):1897-905. doi: 10.2106/JBJS.K . Currently, the incidence of dislocation after the posterior approach has been greatly reduced due to technique and other refinements. 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. There are a number of different surgical ways (approaches) to access the hip joint. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. My husband has a plastic valve (done in 86) and synthetic assending aorta and triple bypass (done in 2013)very successful surgery. The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior https://holycrossleonecenter.com/wp-content/uploads/2018/12/Screen-Shot-2018-12-10-at-3.48.24-PM.png, https://holycrossleonecenter.com///wp-content/uploads/2017/11/Leone-Center-Logo@2x.png, The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior and Direct Anterior, Copyright 2018 - 2023 The Leone Center for Orthopedic 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 . Its been a nightmare for me going into 4 yrs post op soon. I furniture surfed in the house and used a stick outside.I was hopeless with crutches, but I think it is recommended we should use them, particularly to ensure we don't get a limp and build our leg up properly. We have an appointment today to discuss the plan of action. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures.A total hip replacement (total hip arthroplasty or THA . Also available today are larger modular heads, made possible because our plastics are so much better than years prior. Iliotibial (IT band) damage, had 2 months of ART release work on this issue. When done well, your body does well with this technology. There are risks and recovery times associated with surgery. I really appreciate this website. Thanks! Woke up with Occasionally this even requires making a second, separate incision. Your symptoms still sound mechanical, positional and episodic. Infection: You are given IV antibiotics before and after surgery. Ultimately, you and your husband need to choose the surgeon who you both feel will provide the possible best care, based on reputation and your personal comfort level. 2 x week. 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. Nobody wanted to talk I havent dropped in here for a while but here I am almost 5 yrs post op Anterior and Femoral Nerve Damage is very alivewhole thigh is numb, IT band is still very sore and numb. There are a few complications that can occur with anterior hip replacement surgery.