The surgeon I expect to use does the Direct Anterior approach. I have congenital hip dysplasia which has gradually caused more pain as Ive gotten older. I then would strongly suggest you trust that person to decide what approach and what prosthesis predictably will deliver the best results. Both approaches have been shown to have potential in research. Only Dr. Leone will be using the most recent hip technique known as the SPAIRE technique as of 2020. I am wondering if having mild hip dysplasia is a factor in which approach is used. I am scheduled to have total hip replacement surgery in 2 weeks. what is the super path method I've never heard of that before, superpath is just the fancy name for a smaller incision , less trauma and quicker recovery or so they say from what I have read along with more surety of the length of leg . Get Directions, Phone: 954-489-4575 It does mean the surgeon has lots of room to move about though!! In anterior and posterior surgeries, the outcome is essentially the same a new hip. If you were in Los Angeles and needed a THR who would you choose to do your surgery? 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. Do either of your techniques require the traditional anterior or posterior precautions? Both problems are on the right side of my body. Its been 9 months(Ive had it 2xs bf and got rid of it and have tried everything and no results this time). Even if the hip doesnt dislocate, prosthetic or soft tissue impingement is not beneficial. In my experience, almost all patients who have bilateral THRs go to rehabs and not home. I assume PTHR is referring to partial hip replacement. I had the mini-posterior at MGH hospital. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. You should feel good that you are aware of your fears and that it hasnt paralyzed you into not acting. I really dont know where to go from here. 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. I think cutting muscle was in the past. Hey, thanks for the forum topic.Thanks Again. The highly crossed linked polyethylene liners are now the gold standard in this country. I did have numerous blood tests, MRI of knee and hip, total body scan with radio active injection, X-ray knee and hip etc. 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)? How the soft tissues are handled and respected, the patients expectations before the surgery and the surgeons experience do. I absolutely would not insist on minimally invasive surgery and a small incision, especially considering your mom is short, obese and has osteoporosis. What is most important is that the surgery is expertly done, that the tissues are not brutalized, and that the surgeon can see what he or she is doing. This allows you to resume normal daily activities quickly while also returning to normal range of motion and function. What is the best hip replacement option: anterior or Posterior? It was discovered that I had a torn Labrum. 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. Consult your doctor to determine if joint replacement surgery is right for you. What do you mean by painful anterior scarring and soft tissue exposure and trauma? All rights reserved. There is less risk of neurological injury. Dear Dr. Leone, I am having Makoplasty ( robotic imaging) to my right hip in February. What reasons would there be to use the regular over the mini? He also used the term anterolateral. I do not have dials and no one seems to know where the neuropathy stems from. Thigh feels so Heavy and I massage that area a lot. 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. It would be interesting to hear what you have to say Doug. 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? Currently, I seldom do bilateral THRs under a single anesthesia but instead stage the surgeries 2 1/2 to 4 weeks apart, depending on my particular patient and his or her needs and desires. The traditional posterior approach is the most commonly used in the United States and throughout the world (about 70 percent). It exploits the same soft intervals but it typically accomplishes prosthetic implantation and soft tissue balancing through a smaller incision and, more importantly, with less underlying soft tissue dissection. I would discuss fully your goals and concerns. Also had I am going to get evals from 3 docs. I spoke in person to probably 4-5 of his success patients and went with hearing from them. If you have these arthritis symptoms, you should consider a hip replacement: severe hip pain that is not relieved by medication and that interferes with your work, sleep or everyday activity hip stiffness that restricts motion and makes it difficult to walk To learn more, read Here's What to Know if You Think You Need a Hip Replacement. 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. In my last blog post, I discussed minimally invasive surgery with regard to hip replacement. Fax: 954-489-4584 He strongly recommends the anterior approach as the only way to go. 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. When it comes to revision surgery, we rely heavily on the posterior approach. 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. This is actually a good sign. Further, I would contact your insurance carrier and the hospital so you will not be surprised with any unexpected costs. For the prevention, diagnosis, and treatment of hip pain and other problems affecting your hips, call Advanced Sports Medicine Center today at (941) 957-1500. In bed for long periods with little or no movement. I am not sure that is true any more. The doctor is planning a traditional posterior. That I knew this recovery may take 1-2 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. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. If youre impressed by how clean it appears and the movement and professionalism of the staff, that obviously is a good sign. Nerve regeneration can occur up to 18 months following injury, but the chance of full recovery decreases with delay in recovery time. An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. Some people may find that traditional hip replacement surgery is the best option for them, while others may prefer a minimally invasive procedure. I would encourage you to discuss your concerns with you surgeon. Yes, you do have increase risks. Your symptoms still sound mechanical, positional and episodic. 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. Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? It is not a substitute for excellent surgery. Overall, it sounds as if youve had an excellent result and wonderful recovery following your hip replacement. I do not want the approach to dictate the optimal construct which I hope will last 20 years and more. By continuing to browse the site, you are agreeing to our use of cookies. In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. I wrote to you in January, now my surgery is in a couple of weeks. I would suggest seeking out doctors who specialize in hip replacement surgery rather than general orthopedics. 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. Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. An anterior hip replacement is, in many ways, less risky than any other type of hip replacement. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. 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. There are a few disadvantages to hip replacement surgery. Its been 8 months now. 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. Because the patient is lying on his back during the procedure, fluoroscopy or moving x-rays are used to aid in the examination. Before proceeding, it is a good idea to review the recommendations and specific parts that your surgeon may recommend. Sometimes, when a surgeon is working too hard to reconstruct through a very small incision, the ends of the incision tear and the tissues are traumatized. Clearly, yours was. I think researching the hospital where you will have your surgery is very important. A femoral nerve injury is devastating and is more vulnerable during an anterior approach than with other approaches. Hip pain, soreness, and stiffness can quickly become unbearable and sideline us from the things we enjoy the most. There is no way that you can recover fast from having bones cut and shaped and large metal objects inserted into them. According to the meta-analysis, DAA (depressing the anterior hip joint by using a metal rod) is associated with significantly shorter hospitalizations than lateral approaches, as well as increased functional rehabilitation and lower perceived pain during the first few days after surgery. It is critical at time of surgery that an excellent range of motion be created without impingement. Your back does need to be evaluated as well. Fitness going into surgery and speed of recovery seems to be a common theme though. This treatment is much more definitive and predictable. We may request cookies to be set on your device. I would not recommend pushing your surgeon to use one specific approach or another. I think tennis, dancing and horseback riding are fine. This robotic technique can assist in producing an excellent result. Very sorry to hear of the difficulties you experienced! My question is, I am a very active 67 yr old. Ceramic-on-polyethylene is currently the most popular hip replacement material, representing 50.6% of all hip replacement cases back in 2014. Once again, I think your decision to proceed with THR is the most reasonable. I don't think there's a one size fits all when it comes to hip surgery. 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. With much respect I look forward to your reply. I do participate in competitions and showcase presentations. The hip replacement needs to correct the abnormal hip mechanics that lead to the arthritis. I wish you a full and speedy recovery. from publication: Current and . Operating through too small an incision and not releasing tissue that would improve exposure and result in a more balanced joint in my opinion does a disservice. Country. Im hoping to play tennis, go dancing and horseback riding once Ive healed. 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. Hard-on-hard bearings, such as ceramic-on-ceramic as well as metalon-metal articulations, also resulted in larger femoral heads being implanted. I now need the right hip replaced. I think its reasonable to request a tour of the facility where youre considering having the procedure. I think the recovery time is the same though. Sometimes the pain goes away as I walk and sometimes it doesnt. I read hip dislocation is 28% higher after a revision, is it more then 28% after 2 revisions??? If you decide to have your hip replaced in another country, I would consider carefully who would care for you if you develop a complication such as an infection, or a major medical problem like a pulmonary emboli or heart attack after surgery. My mom is obese, short and has osteoporosis. I am 37 and have suffered from AVN since I was 14. However, some offer greater patient benefits than others. 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. Many wonderful physicians are part of various HMO panels. Most patients are able to walk the day of surgery. An anterior hip replacement procedure, on the other hand, performs the same function as an anterior hip replacement in terms of tissue shaving. The only problem Ive had post hip replacement is some on/off again groin pain. The incision made for the operation can be as small as three inches. In the right hands, both approaches do great. Thank you very much for taking time to reply me. An anterior capsule is the only soft tissue cut during this procedure to insert the implants. Surgical Techniques Are my findings that posterior approach in my situation would have been more appropriate? 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. Due to security reasons we are not able to show or modify cookies from other domains. 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. 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. Can you please on the various points in the post and perhaps also elaborate on the last point. 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. Im sorry to hear that you struggled after your first, anterior-approach THR. Going in for THR in July. I would research and find the physician and hospital that will give you the best chance of doing well. I think seeing several surgeons for different opinions is good judgment. 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? Notes on SuperPath experiences good or bad, https://patient.info/forums/discuss/superpath-experiences-good-or-bad-718788. My surgeon does the SuperPath method. I am totally confused and dont know which procedure to choose. Having diabetes and two organ transplants does significantly increase your risk for post-op infection as well as other complications. Does anyone ever attempt to do both at the same time if THR is determined? 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. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. Adult patients who have a deteriorated hip may be candidates for total hip replacement. Our team of experts, doctors, and orthopedic specialists are here to share their knowledge and experience with you in order to help you make informed decisions about your health and well-being. Nobody wanted to talk Hi, Pain is almost gone and I am beginning to get back to my life. Enhanced soft tissue techniques also have been developed which more securely close the tissue around the newly placed prosthesis and set the stage for healing. They thought surgery to repair it would give me about 5 yrs. (I have SCD) It has now become unbearable and I am preparing for surgery. I live in Staten Island and need rt hip replacement. We want the forums to be a useful resource for our users but it is important to remember that the forums are It was also observed to be associated with longer surgery times. I have many patients who are accomplished and passionate ballroom dancers. There are potential drawbacks to anterior hip replacement. I wish you well. It sounds like he did fabulous job. I have done everything I can think of to preserve my right hip, but sadly this too needs replacing. In my experience, the restrictions (or those positions we ask our patients to avoid after surgery) have become much less limiting and are off limits for a much shorter period of time. 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. Thanks! Anterior vs. Posterior, Posterior vs Mini-posterior. The mini-posterior is considered a more straightforward approach then the anterior, resulting in lesser complication rates. Infection. This often leads to a less than optimal component position. I would rather this not happen with my right leg when I have the THR in Jan 2017. Six months ago I had a right posterior THR due to severe scfe; now my right leg is 5/8 longer than my left leg. Third, the procedure is shorter in length and requires less hospital stay than traditional hip replacement surgery. I would discuss fully your goals and concerns. Since these providers may collect personal data like your IP address we allow you to block them here. Im now 6 weeks out and doing good. Will I be able to dance, hike, bike, swim, exercise after a 3rd surgery? If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. In general, people who are older, heavier, or more active may not be good candidates for this type of surgery. No one tells me the same thing? Hospitsl staff 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. I think it perfectly ok to discuss different approaches and ask for an opinion. 2 x week. Its Inosine and Sphingolin. 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. 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. What Ive been able to achieve is find two nerve supplements that have taken away the burn/tingle on my thigh. The Hanna bed, general anesthesia machines, spinal setup, medications, ventilation, instruments, and their sterilization are all prerequisite. We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. My advice is to focus on finding a surgeon with whom you are comfortable and have the best chance of doing well. What you can do is keep as good an attitude as possible and keep rehabilitating your leg. I would avoid the metal-on-metal articulation. 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. It is difficult to get that from information which I find curious. 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. Ive since met 3 others who ended up with the mess that Im dealing with also. 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. 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. Personally I had the posterior approach and cannot see how I could have recovered any faster . With that said, I would have probably just done the posterior with you if we lived in the US based exclusively on the time you take to respond! Every patient needs to have as limited an approach and dissection as possible that does not compromise the final implant position or create excessive trauma to the soft tissues. I think they are happier and rehab more quickly. I dont know if this stems from the knee surgery but I do not believe so because I was well for about a year and a half. 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. I will reiterate what I know to be true. But this blog was a nice nudge toward the posterior. Thanks again! Imagine your femoral head lacking full acetabular coverage, resulting in an overloading of the superior aspect of your socket, hence the cartilage and labrum becoming damaged and ultimately breaking down. Hip replacement via SuperPATH approach had a longer operation time than hip replacement via conventional approaches. What is SuperPath hip replacement? I would not recommend pushing your surgeon to use one specific approach or another. Do you also do arthroscope surgery? Patient Concerns 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 . Most traditional hip replacement models are metal-on-plastic varieties. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. Posterior or Anterior? As a result of this precaution, it is difficult to sit on low chairs, sofas, or toilets. In my experience, there is a faster and more-consistent recovery with the mini-posterior. I recently had a spontaneous hip fx and was diagnosed with hip displasia. Thanks, So my question is in relation to my body structure. Proponents of minimally invasive hip replacement say small-incision operations can lessen blood loss, ease post-operative pain, trim hospital stays, improve scar appearance, and speed healing.. Losing weight and strengthening your muscles pre-operatively will make surgery easier and greatly facilitate your rehab. Your article lacks the pros of the AMIS and the cons of min invasive posterior. 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. It will help desensitize and help get your muscles working in synchrony. Most importantly, I would meet with your surgeon and discuss all of these concerns. Not quite in the past. SuperPath is a portal assisted THA approach that accesses the capsule superiorly through the interval between the gluteus medius and piriformis without requiring the cutting of any muscles or tendons. This is particularly true if the person is overweight, has very muscular thighs or is short. I am thoroughly confused at this point. Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. I'm hoping to read some posts post surgery. 3. An anterior hip replacement is not covered by a specific credential system for orthopedic surgeons. Similarly, an engaged medical team needs to be available to help with care after surgery. 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, the surgeon said that I would end up having one leg shorter than the other is this true? I would like your opinion. Update what hes cutting is the adductor so my question is the same is this just a normal part of some THRs? The hip joint can be supported by the socket, which is designed to fit over the ball and provide stability. The pain I get is in the groin and a sharp pain in the buttocks, that feels like muscle pain. I also think its reasonable to look forward to returning to all of the listed activities that you enjoy. Because I have scfe also in my left hip, I will have to have it fixed too. 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. thank you for your time. Can I make an appointment with you. We are now in a situation where we have found two extremely good surgeons and we gel with both extremely well. What is most important is that you find a surgeon who understands the particular complexities with your problem and whom you trust. This means you could go home within 23 hours after surgery. Changes will take effect once you reload the page. Potentially there also is less pain and a quicker recovery. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. We are always refining and trying to make it better. Hip dysplasia is a very common underlying cause of hip osteoarthritis. Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. THOUGHTS? Also on MRI there was a cyst (good size). 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. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. I went with a total hip replacement. A hip replacement can be delayed until it is absolutely necessary if the replacement parts can fail over time. Ten years ago I had total hip replacement on the left at hss. There is also a small risk of death associated with any surgery. Does either procedure in this discussion present restrictions or advantages for this sort of movement? I have the hospital but am deciding on the surgeon and which approach is best. Your article has made it clear I made the correct decision, especially since my daughter had nerve damage from an operation years ago. Choosing a surgeon based on his or her experience and complication rate also is exactly right., My strong advice is to choose your surgeon, not the approach. If your surgeon has recommended surgery, I assume youre no longer getting adequate relief of pain or able to remain active with conservative measures. Im considering this mini posterior approach. I had the surgery on June 22 and I am about 5 weeks post op. 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. The mini posterior approach works wonderfully and predictably when expertly performed. Can you explain it to me as he didnt go into detail. William Leone. Dr. William Leone. I wish you the very best, 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.