That being said, you should have the additional surgery where you feel you will have the best chance of doing well. Consult your doctor to determine if joint replacement surgery is right for you. 2004 Apr. Since then, SuperPATH has enjoyed excellent success. Our insurance covers both. What are your thoughts with regard to Stem cell therapy in lieu of THR? Before proceeding, it is a good idea to review the recommendations and specific parts that your surgeon may recommend. out the next afternoon and using a walking stick from day 2 to day 10 when I ditched it altogether . Dear Dr. Leone, Im pleased that you will be coming in for an appointment. Surgical approach is important but its just one of many important variables. I wish you well. Often, as the labrum is torn, it leads to a lifting off of hyaline articular cartilage where these two tissues meet, called delamination. My surgeon uses the posterior approach. SuperPath approach uses about a 3-inch incision at the side of . A hip replacement can be delayed until it is absolutely necessary if the replacement parts can fail over time. 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. I have a yr or more off work so I have the time to heal properly but scared to sit or move an Inch as I dont want to dislocate my hip again I dislocated my left hip in a resturant while eating lunch with my 10 yr old we both suffer from ptsd now and stayed in the emergency room for 30 hrs before they rushed me to the city hospital. My husband has a plastic valve (done in 86) and synthetic assending aorta and triple bypass (done in 2013)very successful surgery. I understand that most surgeons now do a spinal rather than general anesthesia. Thank you. i had lateral posterior, my surgeon stopped doing anterior because he said it caused muscle problems moving them about and can also cause nerve damage, which is the main reason I did not want that approach. The anterior approach has a lower incidence of sciatic nerve injury and a higher incidence of femoral nerve injury. I dont know what type of procedure was used for my first op but it was sucessful and now can do a half lotus position with no problem.I do find however that the muscles at the front of that leg are not as strong as my unoperated right leg and lifting the left leg to a vertical position in yoga, when lying on my back, is quite difficult. 2021 May 20;16(1):324 . So my question is in relation to my body structure. I know the most important decision you will make is choosing the doctor who will perform your surgery. . You should consult with your doctor before deciding to have an anterior total hip replacement. Had horrible groin pain issues and opted for the antior, I knew of nothing else as I consulted with a surgeon who was trained in anterior. 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. 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. I, personally, have not had a patient dislocate following a primary total hip replacement in many years. The vast majority of my patients have their surgeries with a simple spinal with IV sedation so they are sleeping throughout the procedure . These other conditions need to be defined and hopefully ruled out as the primary source of pain. I am going to get evals from 3 docs. Most of my patients now go home the day after their surgery or the next. The surgery time is much less with a single joint and therefore the sterile surgical instruments are opened and exposed to the environment for a shorter time. My problem isnt from a worn-down joint with no cartilage. This is described as a posterior approach because the actual hip . There are various ways of doing a hip replacement. I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. I ride horses, water ski and kayak. For many years, I performed bilateral THR and bilateral TKR procedures, but have backed away for a variety of reasons. Click to enable/disable essential site cookies. (I have SCD) It has now become unbearable and I am preparing for surgery. http://holycrossleonecenter.com/blog/hip-resurfacing-or-total-hip-replacement-a-candid-discussion/, http://holycrossleonecenter.com/blog/metal-on-metal-hip-replacements/, I wish you the very best recovery. In the dark to find out about this myself. When the stem is placed in the femur, it still destroys the same amount of bone for implantation, regardless of which approach is used. Having a THR is a major undertaking and it is reasonable to expect the hip construct to function optimally for twenty and more years. If a revision were necessary, even more bone must be destroyed to remove it. I also would find out your surgeons recommendation regarding activities and restrictions. Is it really as good as it sounds? I dont think there is one best prosthetic. Some have features that are more suited to one persons anatomy and needs than others. I am a 70 yr old female with a 4grade thickness loss at acetabulum and head of femur. #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!" Ill know a lot more after we meet and I review your X-rays. It is also important to avoid any sudden movements or twisting motions. The bone isn't dislocated in surgery. I would research and find the physician and hospital that will give you the best chance of doing well. The amount of PT you need after surgery will be determined by you and your surgeon. 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. These stems are a new design, and therefore do not have an established track record. Dear Mary, Even in my practice, which is starting its 27th year, we continue to refine the surgical procedure, pre- and post-operative instructions and rehab (this is huge), pre- and post-operative pain management, and even anesthesia. I really dont know where to go from here. If these values are elevated, further investigation with hip aspiration should be considered. With a bilateral procedure during a single anesthetic, the blood loss would be double and there would be a much higher likelihood that my patient would need transfusion post-operatively. 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. Dr Leone, you make the point several times that the surgeon, not the procedure is most important. 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. What are the experiences of other countries with THR? In my practice, I cement an Exeter stem in a significant percentage of my patients who undergo THR . daniel neeleman net worth . Gary. The anterior approach, as a marketing tool, has grown in popularity among surgeons. Do you have any thoughts on this issue? Would you recommend treating plantar 1st? . What surgical approach is typical for a complex total hip replacement? Being cared for in a hospital that specializes in joint replacement and has an extensive specialty medical staff also is key. Other conditions, to which you alluded, such as having a back condition and an arthritic knee and foot, all can masquerade what the real or most debilitating problem is. I would not recommend pushing your surgeon to use one specific approach or another. Remember, what youre hoping to do is have a hip construct that will last 20 years or more. I wish you a full recovery. About this injury to me. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. My strategy is to make as small an incision as possible, but one that allows for excellent exposure and reconstruction without brutalizing the tissues. Overall, however, anterior hip replacement is a safe and effective procedure with a high success rate. 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). We are always refining and trying to make it better. Hip replacement via SuperPATH approach had a longer operation time than hip replacement via conventional approaches. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. I am allergic to narcotics . There are hybrids of the surgey from what I can see. I was out of bed walking around the evening of the surgery . Walking is the best exercise. Most doctors have and continue to implant hips through the posterior approach. What are the risks involved? Im considering this mini posterior approach. Problem is that we have seen two doctors and both seem great but are on two extreme sides of the fence. Everything does point to posterior being the better of the two, but first i wasnt given a choice, and much easier said to shop for surgeon, than to do it, when only one in this area takes my insurance. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. During the hip replacement procedure, the surgeon makes a small incision near the front of the hip to allow for the removal of damaged anterior bone and cartilage, as well as the implantation of an artificial hip without damaging the surrounding muscles and tendons. 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. I would also like to know about the customized implant, as I havent yet heard much about it. Further, rehab after hip arthroscopy often requires partial weight bearing on the operative side and that would be difficult with newly operated THR on contralateral side. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. I was released to go back to work after only 10 days. The size of the incision is determined by how large and tight the hip/thigh is and how much tissue (fat and muscle) exists between the bones of the hip and the overlying skin. Your back does need to be evaluated as well. I am now 59, still in good condition but that is being compromised by lack of working out as my hips get sore from most everything I try. 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. I ski, hike (steep terrain) with a pack -about 25 pds, kayak, horse back ride, swim, water ski and bike, which is getting increasingly more difficult. You helped me tremendously in my research of the track record of my HMO, now I have one more quick question to run by you. I find it curious that you report having a good result for the first five months after your surgery as this suggests that the surgery was done for the right indication, i.e., you did well and were pleased for the first five months after THR. The hip replacement needs to correct the abnormal hip mechanics that lead to the arthritis. I am a South African and need to make a decision on whether my mother (69) goes for an AMIS or traditional posterior. The most important thing is that tissue is handled gently and trauma is minimized, whichever approach is used. Glad that after lots of PT and massage and medial branch block for back issues with NO!!! What do you consider to be the most important factors in choosing a surgeon? Bleeding at the operative site can occur as a result of an anesthesia reaction, such as an allergic reaction. Mine certainly have. I take care of many individuals who have a total knee and hip replacements on the same side. This complete wall of tissue that surrounds the new hip imparts stability. Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis.Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Thanks so much for this information! My knee and foot and ankle are messed up too since leg ended up at least 3/4 shorter.I wear a shoe lift, but probably needed it sooner than I realized the shorter issue, My knee is pretty stiff and pain when I walk too much, but I deal with it, it bends good, I sleep good, no pain when I do nothing, so Im working all to do NO knee surgery, This hip was ENOUGH to last a lifetime.. Im 76 and use a lot of supplements to save knee and OA in general..I am looking at other protocols for the knee too.not insurance covered, what else is new.if its good, its out of pocket. Some other methods are effective, but they are less effective for patients who leave the hospital earlier. I'm hoping to read some posts post surgery. Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. Adult patients who have a deteriorated hip may be candidates for total hip replacement. Also, since I am only 51, I am concerned about component longevity. Behavior. The art of surgery should mimic a well rehearsed ballet or symphony. I emphasize continuing exercises at home especially walking. I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. With a significant learning curve, it is likely that you will have to replace about 100 hips before you are truly comfortable with the approach. Full Function, Faster . SuperPath brings some of the best benefits such as; earlier ambulation, no loss of strength, quicker recovery, less pain, decreased dislocation risk, and easier exposure for future revision surgery. Hello Dr Leone, This does not necessarily mean they will have more pain or take longer to get well. Hip replacement surgery is less painful than arthritis or fracture-related pain. Possibly, its secondary to an altered gait pattern or hip mechanics. Patients are typi. Hip replacement is a fantastic operation that can help relieve pain, improve daily function, and improve quality of life. 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. Comments about life-long hip restrictions between Posterior, Anteriorlateral and Anterior approaches? I am a sixty five year old active male and need THR on my right hip. Almost all bilateral THR or TKR patients go to a rehabilitation facility after their acute stay, not home. SuperPATH is a micro-invasive method of performing a standard total hip replacement where the surgeon utilizes a smaller initial incision and, more importantly, a very limited dissection in the deep tissues. Had arthroscopy in Jan 15, cleaned up tear and arthritis. There are several positions to avoid after anterior hip replacement, as they can put unnecessary stress on the new hip joint and lead to dislocation. Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. Having diabetes and two organ transplants does significantly increase your risk for post-op infection as well as other complications. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. Download scientific diagram | (a) Components of a total hip replacement; (b) The components merged into an implant; (c) The implant as it fits into the hip [15]. Ive never foulnd information from any doctor or research-site but that there is always no legs-crossing, no more than 90-degrees (for the most part), and no twisting for anything but full Anterior. When the anterior approach is used, the soft tissues in the hip stay intact, allowing for better hip alignment. My husband tells me that I cry out in pai as I turn over during the night. Better luck to you all. I still have a very big limp and still undergoing physical therapy. 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. 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. There are a number of different surgical ways (approaches) to access the hip joint. Sitting seems to irritate it the most. Patients who have this surgery no longer require walkers, canes, or other aids 5 to 7 days after the operation, in comparison to those who have hip surgery. Occasionally this even requires making a second, separate incision. I would then let that person decide with what approach they think they can best accomplish the surgery and deliver the best result. His hip ball was put back in the socket and he has done beautifully since. Check to enable permanent hiding of message bar and refuse all cookies if you do not opt in. This is used when the cartilage in the hip is severely damaged by osteoarthritis or other conditions. Many people seek anterior hip replacement due to the unbearable pain they feel in their hip joints. They thought it would give me about 5 yrs. I encourage you to do the same. The femoral prosthesis is inserted into the hollow part of the femoral shaft. If you have an abnormal anatomy or are morbidly obese, you may not be a good candidate. Even though I was positive I wanted this method done, I was still questioning my decision. 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 is a chance that the hip will fall out of the socket, or that it will be levered out by twisting it. Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. I am feeling like this is a business like everything is else. I still have some questions I hope you can answer as this is so distressful for me. As a result of anterior hip surgery, there is little need for any special care. A couple of things I am hoping you will explain using laymans termology. Back then my surgeon advised me to perform a posterior surgery as opposed to anterior saying that I was overweight, short and a very muscular person and it would be easier and safer to do so. I was thinking of a Hip Resurfacing for my left hip and was convinced by my other top hip surgeons to stay away from it. 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. Thanks! Fort Lauderdale, FL 33334 An anterior hip replacement does not have any limitations based on comfort. If you do not have a hip replacement, you will live a sedentary lifestyle and become overweight. 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 SUPERPATH technique is a tissue-sparing procedure. My gait is off partially due to my hip but also I believe because of my body structure. Select a surgeon based on your impression of that individual: how engaged was he or she in your care, will you have access to that person as well as his or her team before and after surgery? I have/had arthritis in my hips. I exhausted all other non-surgical options, such as physical therapy and meds but to no avail, so now plan to have a THR in March. As of 2020 only Dr. Leone is using the latest hip technique called the SPAIREtechnique where patients no longer have hip precautions after surgery. Any info would be appreciated. Our overall findings suggested that the short-term outcomes of THA through SuperPATH were superior to DAA. I worry that replacing it with a differently configured socket could make things worse rather than helping. Many also mate this with a ceramic femoral head. 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. Extensive release of the posterior capsule including . No one tells me the same thing? Total hip replacement is a step-by-step surgery to replace the hip socket and the ball at the top of the thighbone (femur).
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