Your primary goal should be to find a surgeon in whom you trust and who will take the workmans compensation insurance. The questions youre asking are 100 percent appropriate. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. Its from a malformation. The approach planned is a frequent topic of Continued If an MRI demonstrates no cartilage damage or subchondral cystification (the development of degenerative cysts), a repairable labral tear and minimal dysplasia, then a hip arthroscopy may be considered. Its been a nightmare for me going into 4 yrs post op soon. Thank you. It typically requires a 4 to 5 day hospital stay, 3 to 6 month recovery period . There arent any activities that you can do with a resurfaced hip that you cant do with a total hip. Clots can form in the leg veins after surgery. In the case of a worn or damaged ball and socket, artificial parts can be used to restore joint function. The source of your hip pain must be diagnosed. It is generally agreed that the temporary numbness is more than balanced out by the substantially improved recovery, reduced pain, absence of a limp, faster return to function, and virtual elimination of the risk of hip dislocation. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. As a result of the interventions, the surgeon has a better view of the hip joint. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. Problem is that we have seen two doctors and both seem great but are on two extreme sides of the fence. There does appear to be an increased incidence of stem instability when implanted through the anterior approach, but I believe this is largely a function of the surgeon experience. Thank you for sharing with others the nerve supplements that youre finding affective. About this injury to me. Part of those possibilities includes a better and more comfortable sex life. Patients are told how to use their hip after hip replacement surgeries, which is very different than the usual practice. Dr Leone, you make the point several times that the surgeon, not the procedure is most important. 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)? I would suggest seeking out doctors who specialize in hip replacement surgery rather than general orthopedics. If possible, speak with other health professionals who work at the hospital or at least in the same geographical area. That being said, you should have the additional surgery where you feel you will have the best chance of doing well. Fort Lauderdale, FL 33334 No, I would not tolerate the pain and immobility, if there is a reasonable way to relieve it. My gait is off partially due to my hip but also I believe because of my body structure. With the ease of movements during pregnancy, you will be able to move around more freely. The SUPERPATH technique is a tissue-sparing procedure. Some surgeons will use 2 incisions, both the anterior and superior approach. But this will always prompt you to accept/refuse cookies when revisiting our site. 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. Please do not take this as an attack, but your article seems biased on your experience (great results with min. You should feel good that you are aware of your fears and that it hasnt paralyzed you into not acting. Dr. William Leone. No one tells me the same thing? With degenerative osteoarthritis of the hip developing secondary to a severe slipped capital femoral epiphysis (scfe), recreating normal hip mechanics after THR may have necessitated lengthening the first hip. No groin pain NOW.but all the other mess of it all. Both have valid cons against the others methods and pros on their method. Thanks. I am a very active and young 69 year old female who had a THR on my left side 5 years ago. Im so pleased to learn that you had a good experience. I sit on a cushion in the car to lift me up. One advantage the ceramic-on-polyethylene carries is the lack of . Please comment. Talked to my foot doc and we decided on the Topaz procedure which has good results. Even after the procedure is completed and the patient is on pain medications, pain and discomfort may occur in some cases. As long as you do the necessary surgeries, you will eventually break your femur, but only if you do enough. Ceramic-on-polyethylene is currently the most popular hip replacement material, representing 50.6% of all hip replacement cases back in 2014. I am 37 and have suffered from AVN since I was 14. However, I now have quite severe OA in my right hip apparently I have no cartilage left and have been told by a surgeon that I am just lucky not to be in constant pain. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures.A total hip replacement (total hip arthroplasty or THA . Here is his perspective based on careful observation of outcomes. What is SuperPath Hip Replacement? The art of surgery should mimic a well rehearsed ballet or symphony. I went in with high expectations of coming out so much better off and here I am 5 yrs out limping more than ever and a NUMB thigh and worse knee and weak ankle. This complete wall of tissue that surrounds the new hip imparts stability. No Muscles Cut is for billboards. I was thinking of a Hip Resurfacing for my left hip and was convinced by my other top hip surgeons to stay away from it. The anterior approach, as a marketing tool, has grown in popularity among surgeons. I believe choosing your physician is the most important decision you can make. Im 56 years of age, 6 1 and 180 pounds. Sitting seems to irritate it the most. Even a task as simple as putting on socks and shoes can result in debilitating discomfort when a severely damaged or arthritic hip is involved. Most of the restrictions are removed at that time, although I still advise common sense, particularly for the first three or four months. The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. Im a very healthy long distance bicycle rider. The healing and maturation of this tissue takes time. Optimal component positioning also is critically important for the best stability and longevity. thank you for your time. Very strange The surgeon I went to said he does THR using a lateral approach. The SUPERPATH hip replacement is a new technique using superior capsulotomy that allows for implantation of the total hip components under direct vision through a single incision. Infection. Third, the procedure is shorter in length and requires less hospital stay than traditional hip replacement surgery. Reconstructing the opposite hip hopefully will result in legs that feel more equal. Get Directions, Phone: 954-489-4575 Most individuals who have had total hip replacement surgery fall into this category and simply resume their lives.. Finally, in July 2013, the first SuperPATH Hip replacement in Australia was performed in Nepean Private Hospital, Sydney. In my experience, almost all patients who have bilateral THRs go to rehabs and not home. Anterior vs. Posterior, Posterior vs Mini-posterior. Contact Dr. Moor, Orthopedic Surgeon at Advanced Sports Medicine Center. Technologies, The Leone Center DAA had a lower rate of hospitalization and functional rehabilitation as compared to the lateral approach, as well as a lower perceived level of pain. When the capsule is fully healed, it forms strong ligaments that will eventually regrow (it will take about 4 months for the capsule to form again). 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. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. I went with a total hip replacement. Im sorry to learn that you are so disappointed with your hip replacement. Does my prothesis not last as long since I am now doing a 3rd surgery? 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. Introduction In the United States, a traditional posterior approach is the most commonly used. Otherwise you will be prompted again when opening a new browser window or new a tab. Once you find that doctor, then you need to put your trust in him or her to help you solve this horrible problem so you can return to being active and productive. I would recommend having an honest discussion with the surgeons you are considering. Also, since I am only 51, I am concerned about component longevity. Your frustration is completely understandable. This means you could go home within 23 hours after surgery. I wrote to you in January, now my surgery is in a couple of weeks. Hospitsl staff Clearly, yours was. Posterior or Anterior? Since these providers may collect personal data like your IP address we allow you to block them here. Over the years, these precautions and the length of time to adhere to these limits have been challenged both by clinicians and patients. A hip replacement is an excellent option for people who suffer from significant pain and disability as a result of arthritis in the hip joint. I should think that all your expectations are appropriate for the activities you look forward to, especially considering youve already done so well after your knee replacement. In my experience the approach used to replace a hip does not effect how quickly a patient recovers. The rule of thumb is that recovery occurs over a 12-18 month period following injury. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. The most important variable is how quickly the person is motivated to return to work. I think they are happier and rehab more quickly. This robotic technique can assist in producing an excellent result. Raleighs orthopaedic clinic is board certified and has fellowship training in total joint replacement. The actual length of the incision really is not important, but rather how well the components were implanted and the hip mechanics restored. My husband has a plastic valve (done in 86) and synthetic assending aorta and triple bypass (done in 2013)very successful surgery. Having a THR is a major undertaking and it is reasonable to expect the hip construct to function optimally for twenty and more years. Posterior hip surgery may be the best option if your surgeon makes a larger incision at the side or back of the hip joint. Pain is almost gone and I am beginning to get back to my life. Each approach you list has advantages and disadvantages. It is difficult to get that from information which I find curious. Ken. Its Inosine and Sphingolin. Having physio The bone isn't dislocated in surgery. I have seen 2 doctors one doing posterior, the other anterior. I encourage my patients to talk to other patients for whom Ive cared and learn about their experiences. Most doctors have and continue to implant hips through the posterior approach. From what Ive seen, most THR patients dont need very much PT, although I do encourage exercising in a pool. Every hip implant has benefits and risks. There is less risk of neurological injury. 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 . I take care of many individuals who have a total knee and hip replacements on the same side. This improved quality of life will be beneficial. I love that you take time off to reply to these messages it is commendable. The posterior approach for hip replacement surgery is by far the most common surgical technique used in the United States and throughout the world. 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. I dont think there is one best prosthetic. Some have features that are more suited to one persons anatomy and needs than others. Is it really as good as it sounds? 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 they are really happy, then you probably will be as well. I am suffering from a severe range of motion where I cant put my left sock on or tie my left shoe, I can barely get in and out of low cars and sitting up at a table hurts too! This often leads to a less than optimal component position. Please be aware that this might heavily reduce the functionality and appearance of our site. You should not proceed unless you know in your heart that you will be taken care of in a manner that has the best chance of giving you as perfect a result as possible. 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? Your article lacks the pros of the AMIS and the cons of min invasive posterior. Personally, I would not gamble with my health. I saw a surgeon who does the posterior approach only and will see another on 4/14/15 who does both approaches. 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]. 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. Which is the best? I dont know what happens on that tablewas he in a hurry on Friday afternoon. The anterior approach, as opposed to the lateral or posterior approach, uses a small incision in the front of the hip. Most of my patients now go home the day after their surgery or the next. I would like to share my experience with both procedures. Consult your doctor to determine if joint replacement surgery is right for you. I assume its something near my groin. My legs are very muscular and trim. #1. Surgical approach is important but its just one of many important variables. Surgeons do not cut across muscles. The most common reason or diagnosis that leads me to replace the hips of young women is hip dysplasia. The anterior approach is not as muscle sparing as some would argue. I would not recommend pushing your surgeon to use one specific approach or another. I have been in excruiting pain and unable to do everyday normal activities. I do not want the approach to dictate the optimal construct which I hope will last 20 years and more. Spring 2014 had trouble playing tennis, hip kept feeling like it was popping out of joint, groin pain, aching. I have not seen this before because in the past, the complication from hip surgery were sciatic nerve injury from posterior approach. So my question is in relation to my body structure. Dr. Leone, I am coming in to see you for an appointment for a THR to my left hip. In hopes that THA would let me live my normal life without arthritis, instead I can barely walk more than 100 yards without having to stop, my gait is crooked causing lower back problems and my personal life is less than perfect. There are several positions to avoid after anterior hip replacement, as they can put unnecessary stress on the new hip joint and lead to dislocation. I understand they have good results in Thailand or India for half that. I never seem to know when I am going to get hit with pain. You can also change some of your preferences. emergent norm theory quizlet. In May of 2015, I had a Labial tear repaired. J Bone Joint Surg Am. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. Country. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. My surgeon does the SuperPath method. When the stem is placed in the femur, it still destroys the same amount of bone for implantation, regardless of which approach is used. 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. Initially I was hesitant of THR thinking I was way too young for something so drastic but Ive now been miserable enough long enough that I am welcoming the idea of surgery. The hope is that your nerve injury will recover with time. Can you suggest any pain medication that would not interfere with anti rejection drugs? What are the experiences of other countries with THR? When it comes to hip replacement surgery, the surgeons skill, the patients weight and build, and the surgeons level of experience all have an impact. There are many benefits to posterior hip replacement surgery including a quicker return to daily activities, a more natural feeling hip joint, and a decreased risk of dislocation. I dont think one surgical approach is better or worse than the other for you to accomplish this. Walker to get around. Some patients who have recently had anterior hip replacement may suffer from complications such as wound healing. Use of the forums is subject to our Terms of Use My doctor does not do mini posterior, therefor I have a 6 incision. Hip implants are medical devices intended to restore mobility and relieve pain usually associated with arthritis and other hip diseases or injuries. Every prosthetic joint has a mechanical range of motion. disadvantages of superpath hip replacement. Even if the hip doesnt dislocate, prosthetic or soft tissue impingement is not beneficial. My advice is to have a frank discussion with your surgeon and share these concerns. 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. Dr. William Leone. The pain in my hip is strange in that I can hike uphill and down hill, bike and X-country ski but have a very hard time walking on the flat, especially after sitting for awhile or getting out of bed. With a significant learning curve, it is likely that you will have to replace about 100 hips before you are truly comfortable with the approach. 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.. I have been doing ALOT of research about the different approaches to THR and looking for the absolute best surgeon. Studying a hospital and physicians track record before you commit is important. The most important decision you will make is choosing your surgeon. These are all realistic goals. I had a posterior, the surgeon did not cut any muscle, they just move them now. My mom is obese, short and has osteoporosis. I just saw a patient with a femoral neuropraxia after a anterior approach THR. Your article is the first Ive read in which no muscle or tendons are cut in any approach other than the direct anterior approach. Hip replacement via SuperPATH approach had a longer operation time than hip replacement via conventional approaches. It is critical to make the right decision regarding anterior hip replacement surgery in each case. But this blog was a nice nudge toward the posterior. I dont want a long recovery time as I am very active. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. There is a 1-2% risk of fracture of the femoral neck. I have a tilted sacrum, sway back and a very large posterior. I do not have dials and no one seems to know where the neuropathy stems from. The doctor is planning a traditional posterior. Nobody wanted to talk However, some offer greater patient benefits than others. I ask my patients to restrict certain positions that exceed the mechanical limits of the artificial hip for the first six weeks. . Just because hardware in your foot needed to be removed after repairing what sounds like a calcaneal (heel) fracture, absolutely does not mean that your body rejected the metal / hardware or that your body will reject the prosthesis your surgeon will implant to reconstruct your hip. I would stay away from narcotics. Le has extensive experience in primary joint replacements, complex revision surgery, periprosthetic fractures, and infection management. Hi guys im 43 and live in Australia and due to have hip replacement in 7 weeks but im so confused as my surgeon is doing the posterior and im off work for 6 weeks where i here people having the anterior and going back sooner and no restrictions on hospital discharge any advice. It's cut off and removed through the hole. I had an MRI by a different hip doctor (a preservationist) who diagnosed me with a birth defect (hip dysplasia). Depending on the degree of injury, you may need a knee brace to lock you knee in extension when walking until the quad function returns. The doc I saw yesterday said 4 weeks. Diagnosed possible labral tear. I would focus on the individual doctor, not the approach that the individual choses to use, to deliver the best result. While it is a surgery that does help many, many people, clearly you are struggling. Because the muscle fibers are separated, not cut, the nerve path is not disturbed and the muscle is not injured. Simply, we keep trying to get better. My main concern is that I have a tilted sacrum and a very sway back. I am a 55 year old with a labral tear and moderate arthritis. Welcome to Brandon Orthopedics! I have done everything I can think of to preserve my right hip, but sadly this too needs replacing. I typically do hip replacement on the get anterior approach in 90% of my patients. more nutritious, too. If a revision were necessary, even more bone must be destroyed to remove it. Finally, hip replacement surgery is expensive and may not be covered by insurance. I think speaking to a patient with whom you can relate and who has been treated by the physician youre considering also is invaluable. Back to work/driving in 10 days. Most THR patients do not need significant supervised physical therapy after surgery; they simply do well when their surgery is done well. They also are looking into methods to reduce the risk of infections in artificial joints. In general, people who are older, heavier, or more active may not be good candidates for this type of surgery. According to Dr. Gililand, patients should not try to change their surgeons opinion based on their preferences. It sounds as if you had a wonderful surgeon. I still maintain that by far the most important decision patients must make is choosing the surgeon who will do their surgery and take care of them, then trusting that individual to choose the approach, prosthesis and make a million other decisions that deliver as perfect a result as possible. Most activities of daily living have an element of hip flexion (knee up to head), which is a safe position after the anterior total hip. For many years, I performed bilateral THR and bilateral TKR procedures, but have backed away for a variety of reasons. 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. Obese or extremely muscular people may not be the best candidates for this surgical procedure. I am thoroughly confused at this point. Hello Dr Leone, Considering I had no idea about differences between the two approaches, I said OK and surgery did go well and I was back on my feet in no time. This suggests that something changed after five months. Personally, it I were caring for you, I would have advised you exactly as the orthopedic surgeon who took care of you did. It's cut off and removed through the hole. I am a competitive tennis player in my age division. Many manufacturers are responding to the surgeons desire for shorter stems and many are now available on the market. Lastly, where can I find a great surgeon that takes FL Workmans Comp? I am a 49-year-old female. I had a consult with a surgeon who does posterior and cuts muscle & tendons. Due to security reasons we are not able to show or modify cookies from other domains. By far the most important variable is the doctor who is doing your surgery and managing your post-op care. It is possible that you will be required to avoid certain high-impact activities to protect your new hip. The development of a complete and secure surrounding scar tissue wall or pseudo capsule is critical for stability. I would not recommend pushing your surgeon to use one specific approach or another. The amount of PT you need after surgery will be determined by you and your surgeon. Finally, because my patients are walking the day of surgery, most want to go home rather than to rehab. These scores are not aggregated. Help. Typically, the new cup will be medialized to gain coverage and correct the abnormality that lead to your arthritis. A metal or plastic implant is used to replace a damaged or diseased hipbone. What do you consider to be the most important factors in choosing a surgeon? The surgeon was not at the pre-op meeting, but the PA assured me it was not that big of a deal (but to me, ALL surgery is a big deal!). There is some concern that this weakens the abductor and leads to a limp. Historically in my practice I performed many Bilateral THR and TKR and have backed away from that practice. results, I decided to see and orthopedic doctor was advised to have THR. Time will tell if this generation of shorter press-fit stems fares as well. Do you agree? They thought it would give me about 5 yrs. Thank you for sharing.