During anterior approaches, fracture repair is much more difficult and necessitates the use of a separate incision. Thanks, As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. Better luck to you all. Finally, hip replacement surgery is expensive and may not be covered by insurance. 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. The rest is marketing. In my experience, there is a faster and more-consistent recovery with the mini-posterior. Thank you very much for taking time to reply me. Lateral femoral cutaneous nerve injury is the most common injury incurred during an anterior approach. I think speaking to a patient with whom you can relate and who has been treated by the physician youre considering also is invaluable. Also, the surgeon said that I would end up having one leg shorter than the other is this true? I am thoroughly confused at this point. Initially I was hesitant of THR thinking I was way too young for something so drastic but Ive now been miserable enough long enough that I am welcoming the idea of surgery. Part of those possibilities includes a better and more comfortable sex life. 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. Now 1 yr later dont have buckling/giving out but a lot of pain is there and after walking around, after about 20 minutes it hurts to lift leg forward, also good hip starting to hurt. 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. Third, the procedure is shorter in length and requires less hospital stay than traditional hip replacement surgery. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. Also if the mini posterior approach is so effective when would it not be preferred over the regular posterior approach? In a very positive way, surgical techniques for both anterior and posterior approaches have evolved wonderfully since your surgery was done 10 years ago. The size and placement of the incisions will be different. daniel neeleman net worth . My legs are very muscular and trim. I was released to go back to work after only 10 days. Most patients are able to walk the day of surgery. My two questions are: 1. I am 5 weeks out and have been doing beautifully! Not wanting to go through all the restrictions, I was considering anterior for my right hip, which would require not having it done locally since doctors here have been doing it for only 1 year. Im ready to have the surgery, having been basically bone on bone for several years. (PATH) and Supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty: learning curves and early outcomes. Felt very uninformed and left There are potential drawbacks to anterior hip replacement. Last summer I wiped out on my bike and snapped off the top of my right femur, with a diagonal break. What to Expect This surgical procedure is performed with a patient lying on their side, and a surgical incision made along the outside of the hip. I would encourage you to discuss your concerns with you surgeon. I am a 67 year old woman who has danced semi-professionally and has always been very active including doing Ashtanga yoga and caopeira. With mild dysplasia, positioning and implanting the new cup usually is not more difficult than with other conditions. I have a good surgeon (same one as last time) but I dont know how he would feel about my asking if a mini posterior (or posterior) procedure be carried out, so as to preserve as much strength in my right leg as I now have.Do as many muscles need to be cut in the mini posterior procedure? Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. One thing I do not want is any muscles or tendons cut in the procedure. Each approach you list has advantages and disadvantages. They are encouraged to be very active and most stop using a cane, can drive their cars and are exercising in the pool, just two weeks after surgery. If I do a single hip or knee replacement, that patient is out of bed standing and, in most cases, walking the afternoon of surgery. Although Superpath hip replacement is often a safe treatment, it may be associated with certain concerns, such as increased postoperative pain, as with any surgical procedure. If your surgeon did a great job, that is something to respect. There arent any activities that you can do with a resurfaced hip that you cant do with a total hip. In 2010, more than 310,000 hip replacements were performed in the United States. So im going back to the surgeon that did my left hip and left me in agonizing pain for 2 months after procedure. With SuperPath, there is no surgical dislocation of the hip. Many modern-day femoral stems are considerably smaller or more bone sparing than well-functioning stems of the past. It is not acceptable to lean forward while sitting down or standing up, and it is not acceptable to bend past 90 degrees (as shown in the angle in the letter L). The first surgeon never mentioned this condition at all. 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. Have you recovered by now? A long surgery time, on the other hand, was also associated with DAA. 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. This can be dangerous because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. 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. Ten out of every fifteen hip replacements will be functional for more than 20 years after they are inserted. Im a 50 year old female whose been dealing with hip, leg and back pain for many years, recently diagnosed with OA, and finding that I need a right THR. I am a competitive tennis player in my age division. The highly crossed linked polyethylene liners are now the gold standard in this country. Every . Also, some body structures or anatomy makes approaching a hip anteriorly much more difficult than others. The mini-posterior approach involves separating the muscle fibers of the large buttock muscle located at the side and the back of the hip. 3. There is a chance that the hip will fall out of the socket, or that it will be levered out by twisting it. I never seem to know when I am going to get hit with pain. A hospital outpatient surgery can cost between one-third and one-half the cost of an outpatient surgery atCOSC. I have seen 4 surgeons. Start your day off right, with a Dayspring Coffee Maybe someday our nations health care system will measure up to that of France, Norway, Switzerland and others, in which their governments are investing half of the GDP that we are wasting. Dr. William Leone. We thank you for your readership. Anterior vs. Posterior, Posterior vs Mini-posterior. It is a pity that medicine cannot be as definitive as science but relies on historic figures and the future outcome appears to be a statistical probability! It is critical to consider the pros and cons of each option before making a decision. 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. An anterior hip replacement does not have any limitations based on comfort. There is some concern that this weakens the abductor and leads to a limp. But I am now in chronic low grade pain thats getting worse and dont know what I should do. 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. Its been 9 months(Ive had it 2xs bf and got rid of it and have tried everything and no results this time). Talked to my foot doc and we decided on the Topaz procedure which has good results. It is possible that you will be required to avoid certain high-impact activities to protect your new hip. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. The questions youre asking are 100 percent appropriate. I am 37 and have suffered from AVN since I was 14. United States. This technique avoids cutting muscles and tendons, minimizing surgical trauma and improving the post-operative experience. Ceramic-on-polyethylene is currently the most popular hip replacement material, representing 50.6% of all hip replacement cases back in 2014. A typical recovery time from anterior hip surgery is six months. There are a number of different potential surgical approaches available for hip replacement, each with their own potential advantages and potential drawbacks. My mom is obese, short and has osteoporosis. Very strange It normally takes about 3-6 weeks to resume normal household activities and about 12 weeks to resume recreational activities like bicycling or golfing. However disadvantages include the inability to adjust for leg length differences and a relatively high risk of femoral neck fracture. I have been in excruiting pain and unable to do everyday normal activities. If not, what will my restrictions be? I think stem cell injections will have little chance of doing any good if indeed your hip condition has already progressed to bone on bone. Until now. If they did develop five months post-op, then you have to consider that it could be a manifestation of back pathology compromising a nerve root. 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. I don't think there's a one size fits all when it comes to hip surgery. Also on MRI there was a cyst (good size). 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. Thank you so much for taking the time to inform us! Remain upright . When compared to the anterior approach to hip replacement, which is typically more painful, there are several advantages to recovering from an anterior approach, including the fact that you will not be required to follow any specific anterior hip replacement precautions, such as bending or crossing your leg. Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. For centers like Phoenix Spine and Joint that use a robot, there is . To have your other hip replaced through a different approach is a decision you need to make with your surgeon. I would emphasize choosing your surgeon and not the approach. Once youve decided, you then need to trust that he or she will take the best care of you possible to deliver the best results. After reading your articles, I have decided not to have anterior. I did have a total knee replaced two years ago. Technologies, The Leone Center Have you heard of something like this, and if so, is it worth it? Dr. William Leone. Will meet with doctor soon but when I was finally able to really exercise after surgery I overdid it and developed plantar fasciitis. Its Inosine and Sphingolin. I think researching the hospital where you will have your surgery is very important. Even though I was positive I wanted this method done, I was still questioning my decision. Return to the work place is an individual decision. 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. I also recommend that you look at the track record and reputation of the hospital where the surgery will be performed, especially considering the underlying cardiac and vascular issues. It's a hip replacement surgery where you lie on your side. This suggests that something changed after five months. An anterior-approach hip replacement necessitates a small incision in the groin area on the front side of the leg. This risk is greatest in older females with bone of sub-optimal quality. One of the potential disadvantages is that because the surgery is performed through the front of the hip, there is a risk of damaging the hip joint and the surrounding muscles and tendons. I do not have dials and no one seems to know where the neuropathy stems from. My recommendation is to go back to your surgeon and share your concerns and issues to see if a fresh and thorough reevaluation wont help define the problem(s) and solutions. Also, is it immoral for an 80 year old to have THR and cost the nations health care system $25 $35k? Your article has made it clear I made the correct decision, especially since my daughter had nerve damage from an operation years ago. Femor fracture. Once again, it sounds as if you had a wonderful surgeon, which is the most important variable. Apples to apples which procedure has the lowest incident of complications? My question is, what will my restrictions be? About how much does this cost? Im now 6 weeks out and doing good. You should not proceed unless you know in your heart that you will be taken care of in a manner that has the best chance of giving you as perfect a result as possible. In has been my experience in life that if others are happy and had a good experience then that speaks strongly to me, if I were to do the same thing. I am scheduled to have total hip replacement surgery in 2 weeks. I dont want a long recovery time as I am very active. By adhering to the surgeons instructions as well as their pre- and post-operative instructions, you can reduce your chances of complications. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. If this occurs, the patient may experience pain and swelling. Clearly, yours was. Thank you for sharing. 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. Read our editorial policy. William Leone. I can still do 30-45 mile rides, but I need to take something before each ride, because of the undone left hip. According to Dr. Gililand, patients should not try to change their surgeons opinion based on their preferences. I had to cut some strength exercises out leg lifts, hip sled. I do participate in competitions and showcase presentations. As a result of anterior hip surgery, there is little need for any special care. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. I would focus on the individual doctor, not the approach that the individual choses to use, to deliver the best result. Many also mate this with a ceramic femoral head. For risks she mentioned all the usual I knew about from the first surgery blood clots/loss, dislocation, etc. In 2013 I had a THA done on the left hip. Choose your surgeon. SuperPath hip approach. Many in business or who own their own businesses will stay home for only one week and then return to their work place because they are bored and would rather be productive and busy. OTC nerve supplements suggested by a naturopath. Your article is the first Ive read in which no muscle or tendons are cut in any approach other than the direct anterior approach. I wish you a full and uneventful recovery. If they are really happy, then you probably will be as well. The surgeon does about 200 a year and people say he has a good reputation. Hip replacement currently consists of two major approaches: direct anterior and anterior approaches. I also would encourage you to choose your surgeon first not the procedure, approach or prosthesis. Soon my right hip started bothering me. Some people also tend to form scar tissue and contracture more readily than others. Posterior, mini posterior or anterior? I actually was supposed to get both done at roughly same time but its been 3yrs with this bad right hip, mainly i was in great fear of going through that pain again, but now i think that pain will be better than this everyday pain!! Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. Since then, SuperPATH has enjoyed excellent success. The experiences will vary greatly . 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. Is THR something that can help? Changes will take effect once you reload the page. The anterolateral approach or Watson Jones approach is one of the classical hip approaches that can produce excellent results when utilized for THR. Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer. Complications associated with an anterior approach hip replacement are similar to those associated with standard hip replacement surgeries. I would rather my patient get half as much anesthesia. An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. Uncemented. Also congenital pulmonary hypertension (PA pressure about 52) and have hashimotos hypothyroid, and two additional auto immune issues ( alopecia and psoriasis of feet),and hypertension. We have an appointment today to discuss the plan of action. Really Great. Lastly, if one has had P or AL is there anything that can be done to offset the need for restricitons? Thank you. I would love to hear some stories about the SuperPath hip replacement. I walk a lot in my job and bend lots (work with children) and sitting causes pain due to impingement.
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