If your surgeon cant answer your questions about hip replacement or provides unsatisfactory answers, you may need to consult another surgeon. The first surgeon never mentioned this condition at all. If its a struggle, then the situation needs to be reassessed. Choose your surgeon and not the approach or prosthesis. Surgical approach is important but its just one of many important variables. 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. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. Its been six months since surgery, my operating doctor keeps feeding me with lets wait another month stuff. Lazaru P, Marintschev I. I had no inkling of this till he showed me on the x-ray. The first is that it is a major surgery, so there is a risk of complications such as infection. No specifics were given to me from the orthopedist . Because the muscle fibers are separated, not cut, the nerve path is not disturbed and the muscle is not injured. Im pleased that you will be coming in for an appointment. Getting those studies will not change the reality that you will need THRs. 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. You can be successful by staying healthy by sticking to less pain. There are various ways of doing a hip replacement. Cant afford a dislocation or other complications cause Im sole caregiver for severely handicapped son. There are 5 questions, mobility, self-care, usual activities, pain and anxiety. The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. Some patients report that symptoms increase in the not-yet reconstructed hip because of the leg length inequality. You are to be commended for taking the time to answer our questions. Im so against any other replacements as I have other issues, but working with alternative treatments, out of pocket money, as my hip replacement has been a horrible drama/saga. 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? Many others feel the same. Or are x-rays definitive for determining the exact reason for THR? daniel neeleman net worth . Otherwise you will be prompted again when opening a new browser window or new a tab. I just want to thank you for the information on this site. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. Had a total hip replacement aug 2013. Dr. Leone, I am coming in to see you for an appointment for a THR to my left hip. Back to work/driving in 10 days. Im an avid skier and just found out I did not have full Anterior but rather AL. I would recommend having an honest discussion with the surgeons you are considering. Return to the work place is an individual decision. We have an appointment today to discuss the plan of action. There is a possibility that blood loss may be reduced as there is less unnecessary exposed bone surface left to bleed. Also there are concerns about disruption of blood supply to femoral head with this operation. I suggest you discuss your concerns with your surgeon. He is highly respected by the medical and chiropractic community, so i plan to have a appointment to discuss his plans for my surgery. The pain is really inconsistent, one min I will be walking fine and the next it catches and is very painful, then it may go away or may not. It is difficult to get that from information which I find curious. First, I am a little bit scared. Obese or extremely muscular people may not be the best candidates for this surgical procedure. 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. Can You Use An Inversion Table With A Hip Replacement 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. What are your thoughts with regard to Stem cell therapy in lieu of THR? I sit on a cushion in the car to lift me up. The rest is marketing. I have been told that I can fly 48 hours after surgery?? Honestly, most 59-year-old active women do best with a well done THR. I came home with crutches, abandoned them at the front door and have not used them since. 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. Optimal component positioning also is critically important for the best stability and longevity. These parts have a porous coating that the bone grows into. In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. Also on MRI there was a cyst (good size). Try our Symptom Checker Got any other symptoms? I think its reasonable to request a tour of the facility where youre considering having the procedure. Some patients have no pain at all, which is remarkable. 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. Click to enable/disable Google Analytics tracking. Thanks. I am a sixty five year old active male and need THR on my right hip. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. 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. Traditional Hip Replacement - Traditional surgery requires a large incision of 10 to 12 inches and detachment of muscles from the hip. I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. The source of your hip pain must be diagnosed. The best of luck to you, It's cut off and removed through the hole. It is critical to make the right decision regarding anterior hip replacement surgery in each case. The most important variable is how quickly the person is motivated to return to work. Conclusions SuperPATH approach showed better results in decreasing incision length and early pain intensity as well as improvement of short-term functional outcome. Your blog on anterior vs posterior approach was very informative. Also, after an accident, I had 12 screw and an L shaped plate in my heel. In the right hands, both approaches do great. It all comes down to the surgeons comfort as well as the patients. Some patients who have recently had anterior hip replacement may suffer from complications such as wound healing. Thanks. Please be aware that this might heavily reduce the functionality and appearance of our site. 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. The most important decision you must make is choosing your surgeon. Thank you for this great informative discussion. Thank you. Additionally, there is a small risk of dislocation after surgery, which can be painful and may require additional surgery to correct. 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. I would rather this not happen with my right leg when I have the THR in Jan 2017. I wish you the best of luck. Click to enable/disable _ga - Google Analytics Cookie. Fortunately, if the components are stable (bone-in grown or cemented) and optimally positioned, and the surrounding tissues has fully healed and matured, then that risk is very small. Felt very uninformed and left 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. A number of patients who have undergone this procedure are able to walk unassisted the day after surgery . I was discharged within 24 hours. We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. 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. Hello Dr. An anterior hip replacement is, in many ways, less risky than any other type of hip replacement. Fitness going into surgery and speed of recovery seems to be a common theme though. When studying the hospital credentials, try and learn how many joint replacements are performed at that hospital each year, their infection rate and their 30-day readmission rate. I still have some questions I hope you can answer as this is so distressful for me. Patient Concerns Ceramic-on-polyethylene is currently the most popular hip replacement material, representing 50.6% of all hip replacement cases back in 2014. The surgical area of anterior hip replacement is located in the vicinity of the lateral cutaneous femoral nerve. Does this mean my body may reject the metal of the post or cup? I have seen 2 doctors one doing posterior, the other anterior. The parts may be attached to the bones in one of two ways. Individual results and activity levels after surgery vary and depend on many factors including age, weight and prior activity level. Woke up with Some other methods are effective, but they are less effective for patients who leave the hospital earlier. 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? My mom is obese, short and has osteoporosis. 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. I am so sorry to learn that you are struggling. I emphasize continuing exercises at home especially walking. 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. How long will my hip replacement last? I wish you the best of luck with your care. Consuming excessive-fibre and wholegrain meals will assist to keep you feeling full, and will be Irrespective of the approach that is used to implant the prosthesis, the tissues that surround the new prosthetic hip must heal and mature if the hip is to achieve stability. 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. With mild dysplasia, positioning and implanting the new cup usually is not more difficult than with other conditions. more nutritious, too. Its also reasonable to ask to speak to other patients who have undergone THR using this technique to learn about their experiences and results. More likely, its because ones activity increases after the first THR. Can I make an appointment with you. I believe a THR will benefit you tremendously. Patients who are significantly overweight (I specifically assess the amount of tissue between the skin overlying the lateral hip and the greater trochanter), who have significant long-standing contractures and restricted ROM, congenital dislocation, and marked acetabular protrusion (when the femoral head wears centrally into the acetabulum) typically require a larger incision and more soft tissue releases. Because the gluteus medius and minimus lie over the anterior capsule and insert into the greater trochanter, it does require greater trochanter osteotomy or more commonly a partial elevation of these muscles from their insertion, which can lead to damage. And, I Do. Most THR patients do not need significant supervised physical therapy after surgery; they simply do well when their surgery is done well. Dear Dr. Leone, 5. If you refuse cookies we will remove all set cookies in our domain. Time will tell if this generation of shorter press-fit stems fares as well. 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. This does expose the patient to more radiation but can help with component positioning and sizing. I am planning to have a THR this summer. Which approach did the doctor take? Often, as the labrum is torn, it leads to a lifting off of hyaline articular cartilage where these two tissues meet, called delamination. 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. It was also observed to be associated with longer surgery times. The only problem Ive had post hip replacement is some on/off again groin pain. but it was more torn than they thought and they had to cut out about 1/4 of it. If possible, choose a hospital that specializes in joint replacement and can back that up with excellent statistics and reputation. The doctor used the posterior procedure. I also have undiagnosed neuropathy in both legs from the knees down. It is important to understand that "less invasive" does not only refer to the incision but . Historically, higher dislocation rates were reported with the posterior approach, but it still was used for its many other advantages. When the joint is held together by gravity and asymmetric anterior muscle tension, the tension between the ball and socket may change in various directions. Two which are receiving the most attention are the traditional posterior approach and the direct anterior approach. 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 think it was sensible being careful on the other hand and I was told not to cross my legs. Your out-of-pocket costs for your hipreplacement will be impacted by a number of . Will I still be able to do all of these things? Traditional hip replacement surgery is no longer an option, but it is less painful and has a number of advantages. 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. This surgical procedure is performed with a patient lying on their side, and a surgical incision made along the outside of the hip. Most patients are able to walk the day of surgery. However, some offer greater patient benefits than others. Results of the surgery numbness in the right thigh, inability to stand on the right leg, muscle atrophy all confirmed by EMG and second orthopedic surgeon. Complications from infection account for approximately 10% of all cases. I saw a surgeon who does the posterior approach only and will see another on 4/14/15 who does both approaches. I then would trust your doctor to select the prosthetic that would deliver the best result according to your goals and allow you to return to activities that you enjoy. Femor fracture. This robotic technique can assist in producing an excellent result. not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in I think it is important to define and isolate why youre doing so poorly. No one tells me the same thing? Also if the mini posterior approach is so effective when would it not be preferred over the regular posterior approach? I tore my labrum at age 43 and only discovered then that I had bilateral dysplasia. 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. Thanks again! My question is, I am a very active 67 yr old. I am having the mini posterior done in June and my surgeon gave me the pros & cons of both. With much respect I look forward to your reply. 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 wish you luck on your journey. A hospital outpatient surgery can cost between one-third and one-half the cost of an outpatient surgery atCOSC. A hip replacement can be delayed until it is absolutely necessary if the replacement parts can fail over time. Introduction About my surgery: I had to wait 30 hours before surgery, two days later I was released, within two more days I stopped using my walker. I spoke to the surgeon, he believes it may take up to 6 months to get better from this neuropraxia. If possible, try to get in writing any verbal promises made. Adult patients who have a deteriorated hip may be candidates for total hip replacement. I would not change the position of the components. Patients understand the risks that metal joints and sockets bring to their long-term health and are moving away from the material. I wish your patient well. Others continue to follow traditional guidelines. Soft tissue contractures often are associated with long-standing arthritis. If your surgeon has recommended surgery, I assume youre no longer getting adequate relief of pain or able to remain active with conservative measures. 1.2. Many studies suggest that any limp or clinical weakness resolves after approximately three months. 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). I am totally confused and dont know which procedure to choose. Patients who work for themselves are very motivated to return to work and often do so between procedures. What do you mean by painful anterior scarring and soft tissue exposure and trauma? Hip replacement via SuperPATH approach had a longer operation time than hip replacement via conventional approaches. Anterior vs. Posterior, Posterior vs Mini-posterior. 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. 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. When we quote probability of longevity after hip replacement based on following people who had the operation, it is based on standard length stems. 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. I saw a hip surgeon last year for an opinion, but because I had almost no arthritis on the x-ray he said he saw no need for surgery. 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 . I also would learn about the track record of the surgeon and hospital where you will decide to have the surgery and what implant will be used. Ill know a lot more after we meet and I review your X-rays. A miniposterior approach uses the same intervals as the standard posterior approach but simply less tissue is released for the exposure. Walking is the best exercise. 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). Do you agree? 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 . I am a competitive tennis player in my age division. Specific protocols, therapy and what positions you will be asked to avoid after surgery and for how long will be directed by your surgeon. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. Pam. 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. Dr. William Leone. But Im impressed with your blog and responses, so am writing to ask you about an apparently new procedure in which the surgeon uses a customised implant, utilising pre-operative 3D CT scanning. These cookies collect information that is used either in aggregate form to help us understand how our website is being used or how effective our marketing campaigns are, or to help us customize our website and application for you in order to enhance your experience. The main limitation after surgery is a lack of comfort. Dr. Parsons has extensive experience in the posterior, anterior and superior (SuperPATH) approach to total hip replacement having performed hundreds of each. That I knew this recovery may take 1-2 Other combinations of materials have advantages and disadvantages (for instance, some researchers believe that ceramic-on-ceramic types may be more durable, but they have also been known to make squeaking and popping sounds.) 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 also would find out your surgeons recommendation regarding activities and restrictions. 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. After reading a few articles on anterior vs posterior including yours, I know now that his decision to use the posterior approach is the best one for me! The size and placement of the incisions will be different. 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. Original Medicare (Part A and Part B) will typically cover hip replacement surgery if it's medically necessary. Hip replacement surgery is typically performed in a hospital and requires at least one night in the operating room. You should feel good that you are aware of your fears and that it hasnt paralyzed you into not acting. The femoral prosthesis is inserted into the hollow part of the femoral shaft. These scores are not aggregated. Pain and disability are reduced. According to Dr. Rosen, the most important thing to remember is what you leave behind rather than how you get there. Before proceeding, it is a good idea to review the recommendations and specific parts that your surgeon may recommend. You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. Surgical Techniques In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. Pain Management 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. My husband, who is only 35, has to consider a THA in the near future and Im very torn over which approach as the surgeon we really like dos a posterior but I am concerned about dislocation rates in posterior vs anterior. I play in the 50s age group. 2. I did have a total knee replaced two years ago. As you can see, there are no restrictions. There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. Thank you, Rita. A couple of things I am hoping you will explain using laymans termology. Tina, which procedure did you have?
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