Time will tell if this generation of shorter press-fit stems fares as well. Years!! By far the most important variable is the doctor who is doing your surgery and managing your post-op care. These scores are not aggregated. 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. I had no inkling of this till he showed me on the x-ray. That being said, you should have the additional surgery where you feel you will have the best chance of doing well. The anterior approach typically does not violate this structure. 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. Historically, higher dislocation rates were reported with the posterior approach, but it still was used for its many other advantages. When a patient feels better, they can return to work almost immediately, though it usually takes two weeks or longer. Would you recommend treating plantar 1st? Also if the mini posterior approach is so effective when would it not be preferred over the regular posterior approach? My walking is very limited, shoe is built up as leg is shorter and in recent months Ive realized my leg is bowed. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. I have been less active this past year and am concerned that losing weight prior to surgery might be an issue, Am also wondering about my auto immune issues and the implant. The healing and maturation of this tissue takes time. However, some offer greater patient benefits than others. Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. The most important thing is to get a top notch surgeon and go with whatever approach they offer. Share your concerns with your surgeon. One of the potential disadvantages is that because the surgery is performed through the front of the hip, there is a risk of damaging the hip joint and the surrounding muscles and tendons. as being in breach of those terms. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer. Only Dr. Leone will be using the most recent hip technique known as the SPAIRE technique as of 2020. I wish you a full and satisfactory recovery. He is highly respected by the medical and chiropractic community, so i plan to have a appointment to discuss his plans for my surgery. When it comes to revision surgery, we rely heavily on the posterior approach. A recent article published by the Journal of Bone and Joint Surgery has demonstrated that the direct anterior hip replacement has more blood loss, a higher risk of intraoperative fractures, an overall higher complication rate and no difference in outcomes versus other techniques. It exploits the inter-muscular interval between the tensor fascia lata and the gluteus medius. We thank you for your readership. William Leone. Because my husband has circulation problems in his leg and vein removed for open heart surgery last yearhis surgeon recommended the Mini posterior surgery. But I am now in chronic low grade pain thats getting worse and dont know what I should do. The rule of thumb is that recovery occurs over a 12-18 month period following injury. Good question. The mini posterior approach essentially is the same as the traditional posterior, however a smaller incision is made and less soft tissue is exposed. Also there are concerns about disruption of blood supply to femoral head with this operation. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. So my concerns include having the range of motion to perform moves like promenade where my body is roughly facing forward and my right leg will take a step left across my body at about 90 degrees. It was also observed to be associated with longer surgery times. Not quite in the past. Either and all body types lend themselves to the posterior approach because it is more extensile (can make it bigger and release more soft tissue structure if needed). Occasionally this even requires making a second, separate incision. Really Great. I am just under 5 ft and weigh 185. In the case of a worn or damaged ball and socket, artificial parts can be used to restore joint function. Some of the most common considerations are age, weight, activity level, and the presence of other health conditions. I never seem to know when I am going to get hit with pain. It is possible that you will be required to avoid certain high-impact activities to protect your new hip. I had posterior and much like the superpath trussed into the jig . I think it perfectly ok to discuss different approaches and ask for an opinion. Also, the choice of femoral stem is more likely to be influenced by the approach and not the persons anatomy and hip mechanics. 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. Each is safe, effective, and capable of delivering exceptional results. Im now 6 weeks out and doing good. I have linked back to several blog posts below that will give you more in-depth information. 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)? Since these providers may collect personal data like your IP address we allow you to block them here. 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. The doctor used the posterior procedure. With the ease of movements during pregnancy, you will be able to move around more freely. These are some of the most grateful patients in my practice. I am terrified of nerve damage as I am very athletic and a previous professional ballet dancer. You should consult with your doctor before deciding to have an anterior total hip replacement. Can I expect any problems with the bilateral it was my choice. 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. 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!" It does sound as if proceeding with a THR is appropriate, since your attempt to repair the joint arthroscopically did not pan out. I believe a THR will benefit you tremendously. It is critical to make the right decision regarding anterior hip replacement surgery in each case. I suggest you discuss your concerns with your surgeon. You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. 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. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. I very rarely transfuse any patients now. Should one of these events occur during a mini-posterior procedure, they are easier to recognize and correct. There is a 1-2% risk of fracture of the femoral neck. If youve had a failed hip arthroscopy, almost certainly you also have acetabular pathology and a total hip rather than a partial hip replacement may give you a more consistent, longer-lasting and more perfect result. Ken. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. I plan to retire from working full time June 2017 and am concerned about having appropriate insurance after that. What reasons would there be to use the regular over the mini? Personally I had the posterior approach and cannot see how I could have recovered any faster . An artificial joint is used to replace the worn out hip joint during a hip replacement procedure known as posterior hip replacement. The most common type of total hip replacement is done in the anterior anterior part of the hip. 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. If I do a single hip or knee replacement, that patient is out of bed standing and, in most cases, walking the afternoon of surgery. Some patients have no pain at all, which is remarkable. 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. The most important variable is how quickly the person is motivated to return to work. Why is that? I am a 73 year old woman who has been having severe hip pain for the last seven months. Hip replacement surgery is less painful than arthritis or fracture-related pain. I think the money you spend to have a hip replacement is more than just moral or justified, it is smart business. After all, no matter the age, it will determine the likelihood of maintaining your mobility and independence. Each surgeon approaches these issues individually. I have congenital hip dysplasia which has gradually caused more pain as Ive gotten older. hi im following as im due a superpath soon, there is no one size fits all everyones different I've had 2 hip replacements in 2 yrs one in 2017 then a revision to change the ball and socket to the smallest one they had and now I'm going for a smaller stem I had the anterior approch done which is in the front which is way better then the posterior as the front they can just move ur muscles over to the side to accsess ur hip rather then go through the back or side where they have to cut the muscles. Although anterior approaches can be useful for some, they are not for everyone. Im an avid skier and just found out I did not have full Anterior but rather AL. Very slow recovery. 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. Ann Transl Med. I seem to be able to hike just fine up hill and down but not always on the flat. 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. Uncemented. If this occurs, the patient may experience pain and swelling. Hip replacement is a fantastic operation that can help relieve pain, improve daily function, and improve quality of life. The actual length of the incision really is not important, but rather how well the components were implanted and the hip mechanics restored. Each approach you list has advantages and disadvantages. Or are x-rays definitive for determining the exact reason for THR? All have advantages and disadvantages. 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. Choosing a surgeon should be based on published data (if available), as well as his or her reputation in the community, according to Dr. Delcore. Technologies, The Leone Center Always speak to your doctor before acting and in cases of emergency seek An anterior capsule is the only soft tissue cut during this procedure to insert the implants. 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. He is well known as a top doc for 20 yrs & I was persuaded because the mini posterior has less chance of nerve damage & the surgeon has more options for types of spikes, which your article explains well. Should I be though? Adductors refer to a group of muscles that insert into the medial (inner) upper femur and often become contracted with an arthritic hip. I think it was sensible being careful on the other hand and I was told not to cross my legs. There are potential drawbacks to anterior hip replacement. If you feel confident in your surgeon, I would discuss it frankly follow his or her guidance as to which approach and prosthesis are most appropriate to give you the best result. In my experience, usually releasing the ileopsoas tendon insertion onto to lessor trochanter and medial hip joint capsule, and then manually stretching the leg into an abducted position after THR reconstruction, obviates the need for formal release. 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? Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. This absolutely does not require a special table. It is critical to consider the pros and cons of each option before making a decision. I am going to get evals from 3 docs. Patient is a UK registered trade mark. I would like to share my experience with both procedures. Country. By continuing to browse the site, you are agreeing to our use of cookies. 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. I find that patients who are well informed and know what to expect prior to surgery get well even faster. Last summer I wiped out on my bike and snapped off the top of my right femur, with a diagonal break. Between your legs, you should sleep with a pillow for the next six weeks. Patient does not provide medical advice, diagnosis or treatment. Finally, because my patients are walking the day of surgery, most want to go home rather than to rehab. While new techniques, instruments and prostheses have been developed specifically for minimally invasive surgeries, there are many well-established approaches to hip replacement. I wish you well. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. Regardless, the overall incidence of dislocation for every approach is smaller due to use of larger femoral heads and enhanced closure techniques. 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 individuals who have had total hip replacement surgery fall into this category and simply resume their lives.. When the stem is placed in the femur, it still destroys the same amount of bone for implantation, regardless of which approach is used. thank you for your time. Long-term outcomes of SuperPATH approach need to be investigated. People undergoing traditional hip replacement surgery, for example, are advised not to bend at the hip more than 90 degrees for approximately six weeks after the procedure. No i just had the posterior method which has a larger incision. You should avoid sitting in low chairs, beds, or toilets. My legs are very muscular and trim. Most importantly, I would meet with your surgeon and discuss all of these concerns. Its Inosine and Sphingolin. I weigh 185 and am 54 and realize its ideal to lose weight prior to surgery (working on it as always). 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. There are a few disadvantages to hip replacement surgery. I would look at the published track record of the hospital where the surgery is scheduled to be sure its performance record is good and its incidence of infection is low. No one tells me the same thing? The risk of revision surgery after a posterior hip replacement is the most serious concern. They may be: Cemented to the bone. disadvantages of superpath hip replacement. I have had problems with my hip for the last several yrs. This does not necessarily mean they will have more pain or take longer to get well. Disadvantages of the anterior approach include: Although I am trained in both approaches and have trained surgeons in both approaches, I have stopped using the anterior approach because I saw my patients get well faster, bleed less, and have a more predictable result when I performed the surgery using a mini-posterior approach. 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. Did you have the surgery via Superpath method? Procedures Doc, Ive worked out and been physically active forever running, biking, skating, etc. Depending on the stability and range of motion observed at time of surgery, some doctors dont advise their patients to avoid any positions. 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. I typically do hip replacement on the get anterior approach in 90% of my patients. There are 5 questions, mobility, self-care, usual activities, pain and anxiety. Thank you for all you do and for providing me with the information when I needed it. Also, if a surgeon knows in advance that a certain range of motion is desired, can they provide some adjustment in surgery to help accommodate that desired movement? Infection: You are given IV antibiotics before and after surgery. There is some concern that this weakens the abductor and leads to a limp. Notes on SuperPath experiences good or bad, https://patient.info/forums/discuss/superpath-experiences-good-or-bad-718788. Length of hospital stay with SuperPath hip replacement approach. It also keeps the surrounding muscles and tendons in place to reduce the risk of post-op pain and nerve damage. In my experience, almost all patients who have bilateral THRs go to rehabs and not home. The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. Are these expectations realistic? People who have anterior hip replacements tend to stop using walkers, canes, and other aids 5 to 7 days sooner than people who have conventional hip surgery. About how much does this cost? I do participate in competitions and showcase presentations. It was discovered that I had a torn Labrum. Dr. William Leone, Hello Dr. You can check these in your browser security settings. And does A really have none. I wish you the best of luck. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. Hip replacements might keep you out of action for a considerable period. July 2013 my left hip was scoped for a labral repair. You can resume your active lifestyle as soon as possible thanks to a new prosthetic hip. When the anterior approach is used, the soft tissues in the hip stay intact, allowing for better hip alignment. I would like your opinion. Femor fracture. Ten out of every fifteen hip replacements will be functional for more than 20 years after they are inserted. 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. Click on the different category headings to find out more. Also, only a small percent of C-on-C bearings are being implanted at this time. I spoke in person to probably 4-5 of his success patients and went with hearing from them. 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. The femoral prosthesis is inserted into the hollow part of the femoral shaft. The following cookies are also needed - You can choose if you want to allow them: You can read about our cookies and privacy settings in detail on our Privacy Policy Page. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. Many wonderful physicians are part of various HMO panels. I love that you take time off to reply to these messages it is commendable. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. I would discuss fully your goals and concerns. 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 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. An anterior approach hip replacement is one of the most minimally invasive surgical options for replacing a hip. If I think you may be a candidate, I will refer you to a doctor in our area that does. Mini posterior refers to the approach or tissue interval the surgeon uses to implant the Total Hip. If these values are elevated, further investigation with hip aspiration should be considered. I am thoroughly confused at this point. Obese or extremely muscular people may not be the best candidates for this surgical procedure. Does my prothesis not last as long since I am now doing a 3rd surgery? Finally, hip replacement surgery is expensive and may not be covered by insurance. It is important to understand that "less invasive" does not only refer to the incision but . Each approach has advantages and disadvantages. 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! Being out of bed and moving soon after surgery adds to a patients safety and speeds the recovery. My recommendation is for you to discuss this with your surgeon if you have further concerns. Surgical Techniques Does the mini posterior hip replacement conserve more femur and allow for future surgeries if needed ? For centers like Phoenix Spine and Joint that use a robot, there is . I wish you the very best, Fewer narcotic medications are administered, resulting in a better overall recovery. It seems that whatever their particular approach is that is what they sell. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. I really appreciate this website. There are a few disadvantages to hip replacement surgery. You are to be commended for taking the time to answer our questions. Also, I am diabetic and have had two organ transplants and am extremely worried about infections, etc. I was thinking of doing that 1st, maybe April(Ill be in boot 4 weeks), and then the PTHR in either Sept or next Jan when I have free time. Even after the procedure is completed and the patient is on pain medications, pain and discomfort may occur in some cases. My right leg is already a bit longer than the left. Although Superpath hip replacement is often a safe treatment, it may be associated with certain concerns, such as increased postoperative pain, as with any surgical procedure. Also, be aware that as the nerve recovers, the smallest C fibers within the nerve recover first, which can cause a burning discomfort. Gililand, our physician, explained the concept of health. My doc said the angle of my hips is not the worst but also not the best. Others continue to follow traditional guidelines. 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. Traditional hip replacement surgery is no longer an option, but it is less painful and has a number of advantages. If not, what will my restrictions be? and Privacy Policy and steps will be taken to remove posts identified Egton Medical Information Systems Limited. I tore my labrum at age 43 and only discovered then that I had bilateral dysplasia. Its been 8 months now. There are various ways of doing a hip replacement. Start your day off right, with a Dayspring Coffee General comments will be answered in as timely a manner as possible. Most traditional hip replacement models are metal-on-plastic varieties. A hip replacement can greatly reduce the pain associated with arthritis of the hip, with almost all patients having complete or near-complete relief. I decided to stick with my trusted orthopedic surgeon (who did two knee scopes on me) who believes the minimally invasive posterior approach is the safest approach. No, I would not tolerate the pain and immobility, if there is a reasonable way to relieve it. Getting in and out of cars, and turning over in bed. Im pleased that you will be coming in for an appointment. Personally, it I were caring for you, I would have advised you exactly as the orthopedic surgeon who took care of you did. What do you mean by painful anterior scarring and soft tissue exposure and trauma? I read hip dislocation is 28% higher after a revision, is it more then 28% after 2 revisions??? Im 56 years of age, 6 1 and 180 pounds. Although, personally I would feel strongly about reconstructing the hip through the mini posterior approach (there tends to be considerably less bleeding with this approach), other very caring and competent surgeons might feel just as strongly about using a different approach. Im 51, 59 and 148 and want to get back to tennis etc, this has been long frustrating process. Would not make eye contact. In my experience, most patients who undergo a total hip replacement dont limp after their surgery and most feel their legs are the same length. My advice is to have a frank discussion with your surgeon and share these concerns. I will let you in on something personal. Complications from infection account for approximately 10% of all cases. Iliotibial (IT band) damage, had 2 months of ART release work on this issue. In anterior and posterior surgeries, the outcome is essentially the same a new hip. I had to cut some strength exercises out leg lifts, hip sled. Because of the straightforward exposure of the femur, there is less risk of femoral fracture or poor implant positioning. These can include damage to blood vessels or nerves, dislocation of the hip, and infection. Otherwise you will be prompted again when opening a new browser window or new a tab. I am deciding that my quality of life is in the toilet and need to get the THR done. This is particularly true if the person is overweight, has very muscular thighs or is short. 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.
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