It does sound as if proceeding with a THR is appropriate, since your attempt to repair the joint arthroscopically did not pan out. Registered in England and Wales. Posterior, mini posterior or anterior? In Dr. Lawrence Dorrs opinion, doctors and hospitals should not market a specific type of surgery as the most effective. I'm so encouraged to hear your successful story. You can check these in your browser security settings. Infection: You are given IV antibiotics before and after surgery. Blood clots or bleeding. Thank-you. 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? As of 2020 only Dr. Leone is using the latest hip technique called the. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. Does it really not matter which approach I have, posterior or anterior? I am 37 and have suffered from AVN since I was 14. I think speaking to a patient with whom you can relate and who has been treated by the physician youre considering also is invaluable. I, too, am struggling which approach to have. Posterior hip surgery may be the best option if your surgeon makes a larger incision at the side or back of the hip joint. Dear Dr. Leone, Patients are typi. Excess weight causes a hip joint that has already been stressed to become more painful and disability-causing. The parts may be attached to the bones in one of two ways. A hip replacement with an anterior component does not require major muscle cuts and thus patients are less likely to experience pain and require less medication. 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? I had the mini posterior approach done and it gets better everyday. Hi, Every hip implant has benefits and risks. Because these cookies are strictly necessary to deliver the website, refusing them will have impact how our site functions. You can do anything you want after a hip replacement. I worry that replacing it with a differently configured socket could make things worse rather than helping. Ken. Thanks, SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. 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. I definitely would not recommend a hip scope and THR during one anesthetic setting. With the ease of movements during pregnancy, you will be able to move around more freely. Consult your doctor to determine if joint replacement surgery is right for you. By 2016 and over 300 SuperPATH cases, the results of very first 100 SuperPATH surgeries (the so called 'learning Curve') were published in a peer reviewed journal with . The SuperPATH technique is arguably the least invasive hip replacement technique. Posterior approach. Is the hospital where the surgery will be performed also top rated?. Surgical approach is important but its just one of many important variables. 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. A long surgery time, on the other hand, was also associated with DAA. Start your day off right, with a Dayspring Coffee I would like your opinion. It's a hip replacement surgery where you lie on your side. The vascular supply of your leg must be assessed preoperatively as part of you work-up, but most do very well. Thru X-rays Ive been told both hips are bone on bone! Over the years, these precautions and the length of time to adhere to these limits have been challenged both by clinicians and patients. Finally, many people who are struggling with hip disease experience lower back pain or even sciatic discomfort. I am about to have a hip replacement and would like to know what kind of limitations Ill have afterward. 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. 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. Complications from infection account for approximately 10% of all cases. The surgeon makes 2 incisions one bigger than the other on the rear side and separates the muscle and tendon to get to the hip instead of cutting the muscle and tendons to get to the hip. The traditional posterior approach is the most commonly used in the United States and throughout the world (about 70 percent). 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. 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. I then stage the second surgery as early as 2 or 3 weeks post-operatively. Everyone is. This site uses cookies. It also keeps the surrounding muscles and tendons in place to reduce the risk of post-op pain and nerve damage. 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. 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. Notes on SuperPath experiences good or bad, https://patient.info/forums/discuss/superpath-experiences-good-or-bad-718788. I would then let that person decide with what approach they think they can best accomplish the surgery and deliver the best result. Many others feel the same. I suspect there is significant underlying osteoarthritis related to your labral pathology. Not sure exactly what that means. Ultimately, you and your husband need to choose the surgeon who you both feel will provide the possible best care, based on reputation and your personal comfort level. 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). and Privacy Policy and steps will be taken to remove posts identified Your symptoms still sound mechanical, positional and episodic. It does mean the surgeon has lots of room to move about though!! I have been in excruiting pain and unable to do everyday normal activities. Thank you for sharing. I would discuss fully your goals and concerns. It sounds as if you had a wonderful surgeon. Should I look to another approach and surgeon? There is some concern that this weakens the abductor and leads to a limp. Problem is that we have seen two doctors and both seem great but are on two extreme sides of the fence. I will need the other hip done within the next 6 months, and despite all the talk of the anterior approach- I can use myself as the best judge to the best method. 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. Since I previously had both knees replaced (by another surgeon) about 5 years ago and still have problems with the knees i.e. A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). Most of my patients now go home the day after their surgery or the next. I have written to you to learn what are the surgical considerations for someone with shallow hip sockets like mine. In the hands of a master, all can produce wonderful and predictable results. There is a chance that the hip will fall out of the socket, or that it will be levered out by twisting it. Will I still be able to do the things I like to do? Adults of any age can be considered for a hip replacement, although most are done on people between the ages of 60 and 80. And does A really have none. Your out-of-pocket costs for your hipreplacement will be impacted by a number of . Third, the procedure is shorter in length and requires less hospital stay than traditional hip replacement surgery. 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. About how much does this cost? I also would find out your surgeons recommendation regarding activities and restrictions. I was told to wait 6 weeks before I resumed my exercise regiment. General comments will be answered in as timely a manner as possible. These are some of the most grateful patients in my practice. Each surgeon approaches these issues individually. Possibly, its secondary to an altered gait pattern or hip mechanics. The surgeon I am meeting with (Dr Jimmy Chow) is supposed to be top notch in this procedure, and I am just curious as to how different the surgery is from conventional surgeries. They thought it would give me about 5 yrs. Woke up with I do not do hip arthroscopy. 2012 Oct 17;94(20):1897-905. doi: 10.2106/JBJS.K . 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. When the stem is placed in the femur, it still destroys the same amount of bone for implantation, regardless of which approach is used. I would encourage you to discuss with your surgeon the difficulties and pain you experienced after the first surgery, and together explore if another plan can be created for a better outcome the second time around. Your article is the first Ive read in which no muscle or tendons are cut in any approach other than the direct anterior approach. The anterior approach typically does not violate this structure. If was 3 weeks after discharge Raleighs orthopaedic clinic is board certified and has fellowship training in total joint replacement. Your article lacks the pros of the AMIS and the cons of min invasive posterior. The most important decision you must make is choosing your surgeon. I would not change the position of the components. Many patients approach this by researching online and speaking to other patients who have been cared for at a particular facility. I am totally confused and dont know which procedure to choose. Most patients after a bilateral procedure would not go home but rather a rehab unit. Having physio Felt very uninformed and left Or are x-rays definitive for determining the exact reason for THR? I think its vitally important that you go into surgery truly believing in your heart that you are going to do well, and that you are with the best surgeon and team who will help you. The doctor is planning a traditional posterior. I furniture surfed in the house and used a stick outside.I was hopeless with crutches, but I think it is recommended we should use them, particularly to ensure we don't get a limp and build our leg up properly. This is used when the cartilage in the hip is severely damaged by osteoarthritis or other conditions. 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. I wish your patient well. Because I have scfe also in my left hip, I will have to have it fixed too. I was told the joint lubricant had migrated into the hip bone creating the cyst, There is effusion in the joint and stress areas. The hope is that your nerve injury will recover with time. The amount of PT you need after surgery will be determined by you and your surgeon. Gary. 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 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. My question is, what will my restrictions be? Will I be able to dance, hike, bike, swim, exercise after a 3rd surgery? Just need reassuranceI am stressing he is fine. Sometimes the pain goes away as I walk and sometimes it doesnt. We may request cookies to be set on your device. There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. 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. Obese or extremely muscular people may not be the best candidates for this surgical procedure. from publication: Current and . 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. In bed for long periods with little or no movement. What is your experience and take on this ? So im going back to the surgeon that did my left hip and left me in agonizing pain for 2 months after procedure. A miniposterior approach uses the same intervals as the standard posterior approach but simply less tissue is released for the exposure. Should I be though? Patients can also have as little as a 3-inch incision. Help. I just saw a patient with a femoral neuropraxia after a anterior approach THR. I would look for a surgeon who is busy, has a strong track record and who practices at a hospital with a stellar reputation and where many joint replacement surgeries are done. I would rather my patient get half as much anesthesia. Apples to apples which procedure has the lowest incident of complications? Doc, Ive worked out and been physically active forever running, biking, skating, etc. I think it is important to define and isolate why youre doing so poorly. Is THR something that can help? What are your thoughts with regard to Stem cell therapy in lieu of THR? 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. Return to the work place is an individual decision. 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 question is, I am a very active 67 yr old. Before proceeding, it is a good idea to review the recommendations and specific parts that your surgeon may recommend. Read our editorial policy. Thanks again for this great blog! 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? My surgeon mentioned also cutting something to free me up at the same time he will be doing the posterior approach surgery. I have been doing ALOT of research about the different approaches to THR and looking for the absolute best surgeon. Dr. Tom Miller gives you the five best options for hip replacement surgery. I plan to retire from working full time June 2017 and am concerned about having appropriate insurance after that. Will I still be able to do all of these things? This means you could go home within 23 hours after surgery. This most often leaves the patient with an area of decreased or uncomfortable sensation or numbness over the anterolateral thigh (top, outside area of the thigh), not the entire thigh. I would not anticipate them improving with time, but rather worsening, and I cant imagine you being able to resume the activities you described without having surgery to treat this. 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. This allows you to resume normal daily activities quickly while also returning to normal range of motion and function. I wrote to you in January, now my surgery is in a couple of weeks. It is normal to want to recover quickly and return to a very active lifestyle without pain. I have had both hips replaced about 13 months apart, one anterior and one posterior, and there is no doubt that I would recommend anterior. This technique is also referred to as the . Doctors use metal, ceramic, or plastic replacement parts. Also, since I am only 51, I am concerned about component longevity. He is highly respected by the medical and chiropractic community, so i plan to have a appointment to discuss his plans for my surgery. It was also observed to be associated with longer surgery times. It sounds like he did fabulous job. There are a few complications that can occur with anterior hip replacement surgery. posterior surgery . I am scheduled for total hip replacement in about 3 weeks, and none of these procedures/options were discussed with me.the surgeon just said that it was a risky surgery and he could not guarantee anything! Many of these stems have very little if any long term follow-up, although some appear to be doing well in the short term. Any info would be appreciated. 2015 Aug. 3 (13):179. 2 x week. The first surgeon never mentioned this condition at all. After reading your article I see there are many reasons to go with the posterior approach but nothing about having to use a smaller prosthesis with the anterior approach. A modern artificial hip joint is designed to last for at least 15 years. Thanks! 1.2. My walking is very limited, shoe is built up as leg is shorter and in recent months Ive realized my leg is bowed. I then would strongly suggest you trust that person to decide what approach and what prosthesis predictably will deliver the best results. Others continue to follow traditional guidelines. It is important to understand that "less invasive" does not only refer to the incision but . Choose your surgeon. It's cut off and removed through the hole. That's all I know. I think there may be increased associated complications. crackling noise/pain, cannot bend them or kneel in church or get on the floor to do exercises, I am very afraid to ending up in a wheelchair or having to use a walker the rest of my life.I am a very active 65 year old, and very, very worried about the hip surgery. There is a 1-2% risk of fracture of the femoral neck. We provide the best cash prices and customer care in the industry. 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]. I assume PTHR is referring to partial hip replacement. I am a 67 year old woman who has danced semi-professionally and has always been very active including doing Ashtanga yoga and caopeira. It is 100 percent normal and expected to be scared before surgery. Brian Tinsley. Specific protocols, therapy and what positions you will be asked to avoid after surgery and for how long will be directed by your surgeon. Also, I am diabetic and have had two organ transplants and am extremely worried about infections, etc. For example, the stability of the components could have been achieved initially, but then proved inadequate so you developed either a loose cup and/or a loose stem. Please be aware that this might heavily reduce the functionality and appearance of our site. I think it perfectly ok to discuss different approaches and ask for an opinion. But I am now in chronic low grade pain thats getting worse and dont know what I should do. I very rarely transfuse any patients now. Femor fracture. Getting those studies will not change the reality that you will need THRs. Dr. William Leone, Hello Dr. I am thoroughly confused at this point. We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. Your back does need to be evaluated as well. Share your concerns with your surgeon. Your frustration is completely understandable. I deal with OA lower back mess so know I see most likely how all this has played into the surgery. As for doctors, the surgeon I had came highly recommended. The anterior approach, as opposed to the lateral or posterior approach, uses a small incision in the front of the hip. Please comment. In 2013 I had a THA done on the left hip. Reconstructing the opposite hip hopefully will result in legs that feel more equal. I am so sorry to learn that you have had such a bad experience after THR. 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. This absolutely does not require a special table. appropriate medical assistance immediately. Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. I recently had a spontaneous hip fx and was diagnosed with hip displasia.
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