I had a posterior, the surgeon did not cut any muscle, they just move them now. Your article is the first Ive read in which no muscle or tendons are cut in any approach other than the direct anterior approach. Patients are typi. I did have numerous blood tests, MRI of knee and hip, total body scan with radio active injection, X-ray knee and hip etc. Mine certainly have. Remember, what youre hoping to do is have a hip construct that will last 20 years or more. If a revision were necessary, even more bone must be destroyed to remove it. Hi, A metal or plastic implant is used to replace a damaged or diseased hipbone. Ken. 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. We have an appointment today to discuss the plan of action. I think there may be increased associated complications. The leg lifts really aggravate the front of the hip. If your surgeon has recommended surgery, I assume youre no longer getting adequate relief of pain or able to remain active with conservative measures. The surgical technique for a SUPERPATH Hip Replacement was developed as an advancement to traditional total hip replacement. The anterior approach has a lower incidence of sciatic nerve injury and a higher incidence of femoral nerve injury. Hip replacement surgery is less painful than arthritis or fracture-related pain. When a patient feels better, they can return to work almost immediately, though it usually takes two weeks or longer. I, personally, have not had a patient dislocate following a primary total hip replacement in many years. Also I have read that there is a sharp learning curve that must take place in order to do the direct anterior approach. Thanks. Ann Transl Med. Please comment. Ive never foulnd information from any doctor or research-site but that there is always no legs-crossing, no more than 90-degrees (for the most part), and no twisting for anything but full Anterior. I worry that replacing it with a differently configured socket could make things worse rather than helping. Ten out of every fifteen hip replacements will be functional for more than 20 years after they are inserted. 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. There are a number of different potential surgical approaches available for hip replacement, each with their own potential advantages and potential drawbacks. Raleighs orthopaedic clinic is board certified and has fellowship training in total joint replacement. Im a very healthy long distance bicycle rider. I also have undiagnosed neuropathy in both legs from the knees down. A lot of hospitals and ambulatory surgical centers offer what's called outpatient surgery. Appalachian orthopedic surgeons perform revision surgery as well as mini-posterior and anterior approaches. The best of luck to you, You can also change some of your preferences. I prefer reconstructing the most symptomatic side first. 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. My personal preference has changed from doing both hips during a single anesthetic to staged procedures two to three weeks apart. An anterior approach hip replacement is one of the most minimally invasive surgical options for replacing a hip. It healed well but then I got major psoas pain which a cortisone shot helped. 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. Thank you, 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. Your primary goal should be to find a surgeon in whom you trust and who will take the workmans compensation insurance. Testimonials It is not a substitute for excellent surgery. 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 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). Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. I am experiencing pai. The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior https://holycrossleonecenter.com/wp-content/uploads/2018/12/Screen-Shot-2018-12-10-at-3.48.24-PM.png, https://holycrossleonecenter.com///wp-content/uploads/2017/11/Leone-Center-Logo@2x.png, The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior and Direct Anterior, Copyright 2018 - 2023 The Leone Center for Orthopedic Care. Also if the mini posterior approach is so effective when would it not be preferred over the regular posterior approach? I live in the UK so again Im afraid I wont be able to consult you personally! My advice is to focus on finding a surgeon with whom you are comfortable and have the best chance of doing well. I would encourage you to discuss your expected recuperation time and specific restrictions with your surgeon. It also helps to stabilize the acetabular shell and prevent soft tissue irritation on the out edge of the cup. I deal with major nerve damage on front of thigh, almost whole thigh. You are free to opt out any time or opt in for other cookies to get a better experience. Because of the marked improvement in modern plastics, there is greater longevity and durability of acetabular plastic liners and larger femoral heads are used routinely which results in an improved the head/neck ratio and therefore the jumping distance for a hip to dislocate. In the dark to find out about this myself. In my experience, almost all patients who have bilateral THRs go to rehabs and not home. Very slow recovery. Hey, thanks for the forum topic.Thanks Again. I have read your articles about procedures (anterior vs posterior). That being said, if the foot is now a much bigger problem than the hip, you may have to deal with that first. SuperPath hip approach. I do participate in competitions and showcase presentations. Many of these stems have very little if any long term follow-up, although some appear to be doing well in the short term. Currently we use standard ways, called either posterior or direct lateral approach. I just want to thank you for the information on this site. Since my acetabulum is too shallow, and other angles are off as well, how does the new cup get positioned correctly? 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. 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. I just saw a patient with a femoral neuropraxia after a anterior approach THR. If its a struggle, then the situation needs to be reassessed. Historically in my practice I performed many Bilateral THR and TKR and have backed away from that practice. The most common total hip replacement method is the anterior approach, which allows the surgeon to see better, more precisely place implants, and perform less invasive total hip replacement surgeries. By adhering to the surgeons instructions as well as their pre- and post-operative instructions, you can reduce your chances of complications. Select a surgeon based on your impression of that individual: how engaged was he or she in your care, will you have access to that person as well as his or her team before and after surgery? As for doctors, the surgeon I had came highly recommended. The main limitation after surgery is a lack of comfort. I tore my labrum at age 43 and only discovered then that I had bilateral dysplasia. Therapy is often appropriate for stretching, strengthening and electrical stimulation which helps maintain the motor end plates, structures on the muscles that the nerve branches must re-innervate. There are potential drawbacks to anterior hip replacement. The vascular supply of your leg must be assessed preoperatively as part of you work-up, but most do very well. Problems such as osteoarthritis, rheumatoid arthritis and avascular necrosis can destroy the protective cartilage around the hip joint, disrupting the smooth contact between the femoral head (ball) and hip socket. 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. 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. The anterior approach typically does not violate this structure. Changes will take effect once you reload the page. Due to security reasons we are not able to show or modify cookies from other domains. Currently, I seldom do bilateral THRs under a single anesthesia but instead stage the surgeries 2 1/2 to 4 weeks apart, depending on my particular patient and his or her needs and desires. Occasionally this even requires making a second, separate incision. I am not sure that is true any more. 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. What is most important is that you find a surgeon who understands the particular complexities with your problem and whom you trust. His hip ball was put back in the socket and he has done beautifully since. Any feedback will be appreciated. I still have a very big limp and still undergoing physical therapy. 2. Can you explain it to me as he didnt go into detail. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. 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. I am a 55 year old with a labral tear and moderate arthritis. I have not seen this before because in the past, the complication from hip surgery were sciatic nerve injury from posterior approach. 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. As a result of the interventions, the surgeon has a better view of the hip joint. I emphasize continuing exercises at home especially walking. 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. Share your concerns with your surgeon. Dear Dr. Leone, Click to enable/disable Google Analytics tracking. I had the mini posterior approach done and it gets better everyday. Fitness going into surgery and speed of recovery seems to be a common theme though. Thanks so much for your help, very grateful. My surgeon uses the posterior approach. This absolutely does not require a special table. 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.
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