I wrote to you in January, now my surgery is in a couple of weeks. I had my hip scoped which bought me 8 years, but need a THR now. 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. There are hybrids of the surgey from what I can see. Some in the early period have good track records, others do not. This treatment is much more definitive and predictable. . What, if anything, can be done to revive femoral nerve and get my thigh muscles back in normal? So frustrating. Depending on the stability and range of motion observed at time of surgery, some doctors dont advise their patients to avoid any positions. Doctors use metal, ceramic, or plastic replacement parts. Dear DR Leone, 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. Until now. 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? Traditional hip replacement surgery is no longer an option, but it is less painful and has a number of advantages. During the hip replacement procedure, the surgeon makes a small incision near the front of the hip to allow for the removal of damaged anterior bone and cartilage, as well as the implantation of an artificial hip without damaging the surrounding muscles and tendons. Thanks. There tends to be a lesser incidence of posterior instability with the anterior approach. Most individuals who have had total hip replacement surgery fall into this category and simply resume their lives.. I still have some questions I hope you can answer as this is so distressful for me. The surgeon I expect to use does the Direct Anterior approach. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. I have cared for many patients over the years with significant heart and peripheral vascular disease. 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. Once it exceeds this ROM, impingement occurs. Raleighs orthopaedic clinic is board certified and has fellowship training in total joint replacement. Since a significant amount labrum has been removed, I think another attempt at arthroscopy would prove very disappointing and I would not recommend it. It is critical to consider the pros and cons of each option before making a decision. The surgeon I saw said that my body structure and gait does not affect which approach would be ideal for my body. Obese or extremely muscular people may not be the best candidates for this surgical procedure. Many studies suggest that any limp or clinical weakness resolves after approximately three months. 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. Behavior. We want the forums to be a useful resource for our users but it is important to remember that the forums are No, I would not tolerate the pain and immobility, if there is a reasonable way to relieve it. I would stay away from narcotics. Update what hes cutting is the adductor so my question is the same is this just a normal part of some THRs? 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. 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 walk a lot in my job and bend lots (work with children) and sitting causes pain due to impingement. I deal with major nerve damage on front of thigh, almost whole thigh. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. No one tells me the same thing? Total hip replacement is a step-by-step surgery to replace the hip socket and the ball at the top of the thighbone (femur). The big difference in anterior vs posterior hip replacement is primarily where the incision is made and how long it is. Getting those studies will not change the reality that you will need THRs. Why would the doctor not have that at their finger tips? Nobody wants a long recovery. The new femoral prosthesis and new socket . Most traditional hip replacement models are metal-on-plastic varieties. 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. There are 5 questions, mobility, self-care, usual activities, pain and anxiety. I am a 67 year old woman who has danced semi-professionally and has always been very active including doing Ashtanga yoga and caopeira. A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). Lift your knee rather than your hip at the same time. Everything does point to posterior being the better of the two, but first i wasnt given a choice, and much easier said to shop for surgeon, than to do it, when only one in this area takes my insurance. It can lead to numbness in the thigh and, in rare cases, skin irritation due to the nerves presence. Patients who have this surgery no longer require walkers, canes, or other aids 5 to 7 days after the operation, in comparison to those who have hip surgery. There are a number of different potential surgical approaches available for hip replacement, each with their own potential advantages and potential drawbacks. Finally, many people who are struggling with hip disease experience lower back pain or even sciatic discomfort. Surgical Techniques Some other methods are effective, but they are less effective for patients who leave the hospital earlier. Dr. William Leone, Hello Dr. I would not recommend pushing your surgeon to use one specific approach or another. I wish you a full recovery. 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! I would encourage you to discuss your expected recuperation time and specific restrictions with your surgeon. Patient Resources It allows the surgeon to work between the muscles and tendons without removing them from their anchoring points on the hip or thighbone. Once again, it sounds as if you had a wonderful surgeon, which is the most important variable. The impingement can lead to a levering out of the ball from the socket. My question is, what will my restrictions be? A major muscle is not cut during anterior hip replacement surgery, so pain is reduced and major muscles are not cut after the operation. You can resume your active lifestyle as soon as possible thanks to a new prosthetic hip. It is a pity that medicine cannot be as definitive as science but relies on historic figures and the future outcome appears to be a statistical probability! Driving hurts too. My walking is very limited, shoe is built up as leg is shorter and in recent months Ive realized my leg is bowed. Complications Most patients after a bilateral procedure would not go home but rather a rehab unit. Your surgeon will know better than anyone else just how stable your new hip is immediately after your surgery and how securely the surrounding tissues were repaired after the reconstruction. Not quite in the past. The mini-posterior is considered a more straightforward approach then the anterior, resulting in lesser complication rates. My surgeon wants to use the posterior approach and indicates that I eventually should be able to play golf again. In 2013 I had a THA done on the left hip. The particular surgeon who did your hip is also uniquely qualified to advise you with regard to the postoperative stability of your particular hip, because he or she physically tested your hip intra-operatively. The hip is replaced without the need for surgery to dislocate the joint. However, some offer greater patient benefits than others. 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. Studying a hospital and physicians track record before you commit is important. Im 51, 59 and 148 and want to get back to tennis etc, this has been long frustrating process. It helps the surgeon implant the acetabular component in a very precise position. 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. Comments about life-long hip restrictions between Posterior, Anteriorlateral and Anterior approaches? Some of the most common considerations are age, weight, activity level, and the presence of other health conditions. This means you could go home within 23 hours after surgery. . Also if the mini posterior approach is so effective when would it not be preferred over the regular posterior approach? My advice would be to avoid the extremes of any motion that exceed your hips ROM. Woke up with Our team of experts, doctors, and orthopedic specialists are here to share their knowledge and experience with you in order to help you make informed decisions about your health and well-being. Also, patients with shorter femur necks and genu varus (lower angle between the shaft of the femur and the femoral neck) are more difficult anteriorly. I am now bracing myself for THR surgery within the next year and am wondering if there is any big advantage in trying to have this done by a surgeon who offers the customised implant, as above. My hope is that some of these symptoms will improve with time. 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. Any feedback will be appreciated. There are a number of different surgical ways (approaches) to access the hip joint. My worry is that I will end up with one leg shorter than the other. My mom is obese, short and has osteoporosis. Some hospitals and surgery centers are promoting one method of hip replacement over another. If not, what will my restrictions be? My surgeon uses the posterior approach. 3. 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. Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. 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). SuperPath brings some of the best benefits such as; earlier ambulation, no loss of strength, quicker recovery, less pain, decreased dislocation risk, and easier exposure for future revision surgery. as being in breach of those terms. With the ease of movements during pregnancy, you will be able to move around more freely. She provided all kinds of benefits with this approach, as faster recovery, less motion restrictions et.al. I had to cut some strength exercises out leg lifts, hip sled. Posterior approach. An anterior hip replacement does not have any limitations based on comfort. And, I Do. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. I wish your patient well. 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. The hope is that these new designs will, but time will tell. Having diabetes and two organ transplants does significantly increase your risk for post-op infection as well as other complications. In the case of a worn or damaged ball and socket, artificial parts can be used to restore joint function. 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! Walker to get around. I had the posterior approach, the surgeon did not cut any muscle plus I had no pain at all after the op. Finally, hip replacement surgery is expensive and may not be covered by insurance.