Lateral femoral cutaneous nerve injury is the most common injury incurred during an anterior approach. Would not make eye contact. When compared to the anterior approach to hip replacement, which is typically more painful, there are several advantages to recovering from an anterior approach, including the fact that you will not be required to follow any specific anterior hip replacement precautions, such as bending or crossing your leg. A major muscle is not cut during anterior hip replacement surgery, so pain is reduced and major muscles are not cut after the operation. I try not to let it get to me, but it causing me to feel handicapped. My physical life is diminished. There are 5 questions, mobility, self-care, usual activities, pain and anxiety. Being out of bed and moving soon after surgery adds to a patients safety and speeds the recovery. Will I be able to dance, hike, bike, swim, exercise after a 3rd surgery? 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. Fortunately, if the components are stable (bone-in grown or cemented) and optimally positioned, and the surrounding tissues has fully healed and matured, then that risk is very small. Any info would be appreciated. Thanks again! Many of these stems have very little if any long term follow-up, although some appear to be doing well in the short term. Click to enable/disable _gat_* - Google Analytics Cookie. Do you have any thoughts on this issue? That's all I know. Bleeding at the operative site can occur as a result of an anesthesia reaction, such as an allergic reaction. A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. That being said, you should have the additional surgery where you feel you will have the best chance of doing well. There are risks and recovery times associated with surgery. 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. If your surgeon did a great job, that is something to respect. 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. This approach has a number of potential advantages, including a shorter hospital stay, less pain, and a quicker recovery. This technique is also referred to as the . Because of the restricted view provided by the anterior incision, the anterior incision is a technically demanding procedure. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. It is not a substitute for excellent surgery. My doctor does the Posterior approach, he didnt say anything about the mini part. If I have a 2nd revision of my right hip is it posterior approach or the mini-posterior approach as you discuss above? I can still do 30-45 mile rides, but I need to take something before each ride, because of the undone left hip. Many also mate this with a ceramic femoral head. I worry that replacing it with a differently configured socket could make things worse rather than helping. If these values are elevated, further investigation with hip aspiration should be considered. There is no definitive answer to this question as different people will have different opinions and preferences. Dr. Leone, I am coming in to see you for an appointment for a THR to my left hip. (I have SCD) It has now become unbearable and I am preparing for surgery. Also, in the U.S., nearly all stems which are being implanted through the anterior approach are press-fit rather than cemented. One thing I do not want is any muscles or tendons cut in the procedure. 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. 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. With the ease of movements during pregnancy, you will be able to move around more freely. In general, if someone is dedicated to the job, the return is very quick. 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. Lastly, where can I find a great surgeon that takes FL Workmans Comp? A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. I'm scheduled for THR on the 22nd. Once again, it sounds as if you had a wonderful surgeon, which is the most important variable. It is also possible to have an anterior hip replacement during pregnancy. Its Inosine and Sphingolin. My doctor does not do mini posterior, therefor I have a 6 incision. I still have some questions I hope you can answer as this is so distressful for me. Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. General comments will be answered in as timely a manner as possible. So im going back to the surgeon that did my left hip and left me in agonizing pain for 2 months after procedure. An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. He strongly recommends the anterior approach as the only way to go. I would like your opinion on the stem cell injections as I am really afraid of the second surgery on the same side of my body. I was out of bed walking around the evening of the surgery . I wish you a full and uneventful recovery. I was not aware that any of the local surgeons who is doing anterior approach. If not, what will my restrictions be? The doctor is planning a traditional posterior. Very slow recovery. Potential Disadvantages of Anterior Hip Replacement Anterior hip replacement does have a few limitations: There may be wound healing issues Research suggests that people who undergo anterior hip replacement may be more likely to have a problem with wound healing, particularly infection. 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. Each is safe, effective, and capable of delivering exceptional results. Not only was my recovery twice as fast with the anterior, there was very little pain in comparison. I suspect that your surgeon has continued to refine his or her technique based on experience over the past five years, in the same way I have. Supercapsular Percutaneously-Assisted Total Hip surgery or SuperPATH surgery is a novel method of hip replacement where your surgeon can perform total hip replacement through 2-3 inch incision into the tip of the hip and without dislocating the hip or damaging the surrounding soft-tissue (muscles and tendons). These are all realistic goals. I dont know what happens on that tablewas he in a hurry on Friday afternoon. The actual length of the incision really is not important, but rather how well the components were implanted and the hip mechanics restored. I think its reasonable to request a tour of the facility where youre considering having the procedure. Between your legs, you should sleep with a pillow for the next six weeks. 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. They may have a certain cut-off criteria (for example, a BMI of less than 35). Im considering this mini posterior approach. My husband, who is only 35, has to consider a THA in the near future and Im very torn over which approach as the surgeon we really like dos a posterior but I am concerned about dislocation rates in posterior vs anterior. 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). Iliotibial (IT band) damage, had 2 months of ART release work on this issue. Being cared for in a hospital that specializes in joint replacement and has an extensive specialty medical staff also is key. Risks of Hip Replacement Surgery The major risks include the following: Blood clot: We do reduce risk of this by using blood thinners (Enoxaparin, Aspirin or Coumadin), TED hose (compressive stockings) and compression boots on your feet to increase circulation. I have the hospital but am deciding on the surgeon and which approach is best. I am experiencing pai. Please do not take this as an attack, but your article seems biased on your experience (great results with min. Further, I would contact your insurance carrier and the hospital so you will not be surprised with any unexpected costs. In 2010, more than 310,000 hip replacements were performed in the United States. Yes, you do have increase risks. Thanks. I am allergic to narcotics . The approach planned is a frequent topic of Continued There is a 1-2% risk of fracture of the femoral neck. There are a few disadvantages to hip replacement surgery. As a result of this precaution, it is difficult to sit on low chairs, sofas, or toilets. One advantage the ceramic-on-polyethylene carries is the lack of . Finding the right surgeon is critical, because your care is about so much more than just fixing your hip. Remain upright . Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? SuperPath approach is the least invasive due in part to the minimal amount of tissue damage. I am temped to wait but it is getting worse. I thought the newer procedure on the special table was the best way to go. The vascular supply of your leg must be assessed preoperatively as part of you work-up, but most do very well. It is normal to want to recover quickly and return to a very active lifestyle without pain. The femur is prepared with the head and neck intact reducing the chance of fracture. 3. Inpatient footage of the patient compilation has been edited out to accommodate hospital rules. However, some offer greater patient benefits than others. There always are conditions or circumstances that may predispose one to limp or feel as if their legs are not the same length after surgery, but in my experience this is the exception. Everyone I know that has had both posterior and anterior surgery say not to even consider posterior. Going in for THR in July. Total hip replacement is one of the most successful operations ever developed and is a remarkably predictable way to relieve pain from arthritic conditions. Dr Leone, you make the point several times that the surgeon, not the procedure is most important. I weigh 185 and am 54 and realize its ideal to lose weight prior to surgery (working on it as always). I think researching the hospital where you will have your surgery is very important. I havent dropped in here for a while but here I am almost 5 yrs post op Anterior and Femoral Nerve Damage is very alivewhole thigh is numb, IT band is still very sore and numb. This can cause you persistent pain, stiffness . SuperPath is a portal assisted THA approach that accesses the capsule superiorly through the interval between the gluteus medius and piriformis without requiring the cutting of any muscles or tendons. Many modern-day femoral stems are considerably smaller or more bone sparing than well-functioning stems of the past. 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. I also think its reasonable to look forward to returning to all of the listed activities that you enjoy. What is the best stem and ball/socket combo to use for someone that ones to play tennis? Personally, I would not gamble with my health. The traditional posterior approach is the most commonly used in the United States and throughout the world (about 70 percent). 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. No specifics were given to me from the orthopedist . Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. I read hip dislocation is 28% higher after a revision, is it more then 28% after 2 revisions??? The vast majority of my patients return to work one to three weeks post-operatively. Having physio It is nice to see honest Q&A versus a marketing page. Because of the concerns of posterior dislocation, in the past patients were taught certain positions to avoid. I suspect that your surgeon has continued to refine his or her technique based on experience over the past five years, in the same way I have. 2021 May 20;16(1):324 . The surgeon I went to said he does THR using a lateral approach. I tore my labrum at age 43 and only discovered then that I had bilateral dysplasia. Raleighs orthopaedic clinic is board certified and has fellowship training in total joint replacement. Tossed the cane at three weeks and went back to work. Adults of any age can be considered for a hip replacement, although most are done on people between the ages of 60 and 80. The pain I get is in the groin and a sharp pain in the buttocks, that feels like muscle pain. Welcome to Brandon Orthopedics! It is important to understand that "less invasive" does not only refer to the incision but . My surgeon uses the posterior approach. The rest is marketing. I wish you only the best, Thanks. I think seeing several surgeons for different opinions is good judgment. I encourage my patients to talk to other patients for whom Ive cared and learn about their experiences. It also helps to stabilize the acetabular shell and prevent soft tissue irritation on the out edge of the cup. Pain and disability are reduced. Femor fracture. How do you ask your doctor the questions you want to ask? There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. I had an anterior approach hip replacement. Dear Dr. Leone, Due to security reasons we are not able to show or modify cookies from other domains. 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. They may be: Cemented to the bone. Disadvantages of the anterior approach include: The nerve which supplies sensation to the front and side of the thigh is vulnerable. Complications Also on MRI there was a cyst (good size). The new femoral prosthesis and new socket . For risks she mentioned all the usual I knew about from the first surgery blood clots/loss, dislocation, etc. In my last blog post, I discussed minimally invasive surgery with regard to hip replacement. Also, after an accident, I had 12 screw and an L shaped plate in my heel. Which is the best? Is a prerequisite for THR to have a MRI or Pet Scan? All rights reserved. It is critical to make the right decision regarding anterior hip replacement surgery in each case. 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. In the case of a worn or damaged ball and socket, artificial parts can be used to restore joint function. The anterior approach typically does not violate this structure. There is a chance of nerve injury with any type of hip replacement. Hip replacement surgeries are becoming increasingly popular due to their numerous benefits, such as increased range of motion, reduced pain and disability, improved mobility during pregnancy, and improved quality of life. I understand that most surgeons now do a spinal rather than general anesthesia. Depending on the stability and range of motion observed at time of surgery, some doctors dont advise their patients to avoid any positions. Hi Frances, did you have surgery posterior Superpath? It is a mix of anterior & posterior. 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. from publication: Current and . Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. We now have too many other proven bearing surfaces available. If your little voice is questioning if you are overdoing it or hurting yourself, then listen to it and ease up. As a result of anterior hip surgery, there is little need for any special care. Fortunately, the incidence of hips dislocating after THR is very small, especially after first-time hip replacement. Le has extensive experience in primary joint replacements, complex revision surgery, periprosthetic fractures, and infection management. In another day I was able to take short walks without any limping, etc.. Some people may find that traditional hip replacement surgery is the best option for them, while others may prefer a minimally invasive procedure. Because the anterior hip replacement surgery is a minimally invasive procedure, no cuts are made to the muscles surrounding the hip. Introduction. Once again, I think your decision to proceed with THR is the most reasonable. The only problem Ive had post hip replacement is some on/off again groin pain. daniel neeleman net worth . Since then, SuperPATH has enjoyed excellent success. Long recovery but all is well. I had my hip scoped which bought me 8 years, but need a THR now. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. Because of the straightforward exposure of the femur, there is less risk of femoral fracture or poor implant positioning. The questions youre asking are 100 percent appropriate. Ill know a lot more after we meet and I review your X-rays. Doc says once recovered I should avoid flexion with adduction and internal rotation. Common conditions that often lead people to have either posterior or anterior hip replacement surgery include the following: Osteoarthritis Rheumatoid Arthritis Osteonecrosis, also known as Avascular Necrosis Injury Fracture Bone Tumors There are various ways of doing a hip replacement. Currently we use standard ways, called either posterior or direct lateral approach. This is described as a posterior approach because the actual hip . That being said, if the foot is now a much bigger problem than the hip, you may have to deal with that first. 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). Thanks. He treats a variety of hip, knee, and shoulder conditions, and performs hip and knee total joint replacements. 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! It healed well but then I got major psoas pain which a cortisone shot helped. Is it really as good as it sounds? It is not acceptable to lean forward while sitting down or standing up, and it is not acceptable to bend past 90 degrees (as shown in the angle in the letter L). Please be aware that this might heavily reduce the functionality and appearance of our site. 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. Stay was 2.5 days. Im hearing no restrictions (once recovery is done) for Anterior, but always some for the other two. Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. A lot of hospitals and ambulatory surgical centers offer what's called outpatient surgery. Because the femur is more difficult to expose during the anterior approach vs. the posterior approach, many surgeons will select a shorter femoral component to facilitate reconstruction and lessen chance of fracture. I find that patients who are well informed and know what to expect prior to surgery get well even faster. Publications Im 56 years of age, 6 1 and 180 pounds. I would also like to know about the customized implant, as I havent yet heard much about it. Sometimes, it simply isnt possible to accomplish. 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? Once youve decided, you then need to trust that he or she will take the best care of you possible to deliver the best results. Fax: 954-489-4584 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. What surgical approach is typical for a complex total hip replacement? I am 5 weeks out and have been doing beautifully! I am an obese female and will be 62 in February. Part of those possibilities includes a better and more comfortable sex life. From what Ive seen, most THR patients dont need very much PT, although I do encourage exercising in a pool. Country. The amount of PT you need after surgery will be determined by you and your surgeon. I am seriously looking at the infection rate at each facility. Tina, which procedure did you have? Third, the procedure is shorter in length and requires less hospital stay than traditional hip replacement surgery. Like you said, consistent outcome is important and this surgeon is excellent and I have great faith in him (Im a physical therapist and see his patients post-op so get to see the, at least short term, results myself).