From what I’ve seen, most THR patients don’t need very much PT, although I do encourage exercising in a pool. Thank you. Both have valid cons against the others methods and pros on their method. This complete wall of tissue that surrounds the new hip imparts stability. I am 56 now and find that physical therapy and chiropractic care don’t seem to be helping anymore. Everyone is. Thank you, Lisa Blumthal. The art of surgery should mimic a well rehearsed ballet or symphony. General comments will be answered in as timely a manner as possible. Thanks so much for your help, very grateful. Fort Lauderdale, FL 33334 Also, only a small percent of C-on-C bearings are being implanted at this time. 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. I, personally, have not had a patient dislocate following a primary total hip replacement in many years. Because of the straightforward exposure of the femur, there is less risk of femoral fracture or poor implant positioning. I really don’t know where to go from here. 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. 1000 NE 56th Street, The benefits of this surgery include a small incision, decreased time in the hospital, and a decrease in the amount of time it takes to rehabilitate. I emphasize continuing exercises at home especially walking. What is most important is choosing your surgeon. Why is that? It helps the surgeon implant the acetabular component in a very precise position. What are your thoughts on the use of robotics? I understand and respect that many surgeons prefer doing them simultaneously. Share your concerns with your surgeon. In the right patient, it can be an effective, safe, and durable way to treat many of the problems that come with severe arthritis of the hip. But I am now in chronic low grade pain that’s getting worse and don’t know what I should do. You should feel good that you are aware of your fears and that it hasn’t paralyzed you into not acting. 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. After a slip and fall at work 2 1/2 years ago I need a THR on my left hip. These stems are a new design, and therefore do not have an established track record. No special surgical equipment is required when performing a mini posterior. The hope is that your nerve injury will recover with time. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. Back to work/driving in 10 days. Thanks again! Determining which technique to use will depend on several factors including bone quality and strength. Dr. William Leone. I’ve since met 3 others who ended up with the mess that I’m dealing with also. No one tells me the same thing? The most important variable is how quickly the person is motivated to return to work. Can you please on the various points in the post and perhaps also elaborate on the last point. I’m considering this mini posterior approach. All of these releases may be necessary as part of the surgery and patients do well. The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior and Direct Anterior - The Leone Center for Orthopedic Care 08-10-2017, 05:59 PM jaminhealth Posterior hip replacement surgery uses a curved incision on the side and back of the hip. 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. It seems that whatever their particular approach is that is what they “sell”. I’ve come to the conclusion that perceived benefits do not outweigh the risks with the anterior approach, especially when I can achieve the same or more using the mini-posterior. I was thinking of doing that 1st, maybe April(I’ll be in boot 4 weeks), and then the PTHR in either Sept or next Jan when I have free time. They thought it would give me about 5 yrs. It’s been my experience that femoral nerves tend to recover more readily than sciatic nerves. With much respect I look forward to your reply. I encourage my patients to talk to other patients for whom I’ve cared and learn about their experiences. We also use different external services like Google Webfonts, Google Maps, and external Video providers. The amount of PT you need after surgery will be determined by you and your surgeon. It requires surgical insight and skill to accomplish. Additionally, there are fewer post operation restrictions put on an anterior procedure. It’s been six months since surgery, my operating doctor keeps feeding me with “let’s wait another month” stuff. Do you have any advice or ballroom dancer THR stories to share? What is the best stem and ball/socket combo to use for someone that ones to play tennis? A mini posterior approach is a modification of the classical posterior approach. Just like the shoulder, the hip joint is a ball-and-socket joint; thus, the prosthetic (artificial) portion of the hip joint consists of two parts: a cup-like component that is attached to the acetabulum (a portion of the pelvic bone) to make a socket, and a shaft with a round top that attaches to the femur (long bone of the leg) to make up the ball. This site uses cookies. I assume PTHR is referring to partial hip replacement. The overwhelming response to that blog article (click on the link above to view) prompted me to provide this update. Many believe that this results in less risk of infection. Thanks. My surgeon wants to use the posterior approach and indicates that I eventually should be able to play golf again. I think there may be increased associated complications. What, if anything, can be done to revive femoral nerve and get my thigh muscles back in normal? The posterior surgical procedure has the longest recovery time, but most THR surgeons can perform it. I’ve done PT and plan to continue working on strengthening my core and flexibility of those large muscles. If possible, choose a hospital that specializes in joint replacement and can back that up with excellent statistics and reputation. My advice is to focus on finding a surgeon with whom you are comfortable and have the best chance of doing well. I take care of many individuals who have a total knee and hip replacements on the same side. Currently, the incidence of dislocation after the posterior approach has been greatly reduced due to technique and other refinements. Of note, I am a RN with 30 years of experience and took this decision very seriously. I think it’s reasonable to request a tour of the facility where you’re considering having the procedure. This in turn, can prolong recovery time … There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. Because the dissection is over the front of the hip, a number of patients will experience residual pain and tightness anteriorly (in the front of the hip) at least early on. Doc says once recovered I should avoid flexion with adduction and internal rotation. I wish you a full and satisfactory recovery. It sounds as if you had a wonderful surgeon. Pain modifying drugs as well and as a course of NSAIDs might also be appropriate. Recognize that the underlying etiology is not being corrected by this procedure, so relief of symptoms probably will be temporary and possibly partial. I would encourage you to discuss your concerns with you surgeon. Many others feel the same. Hip dysplasia is a very common underlying cause of hip osteoarthritis. I’ll know a lot more after we meet and I review your X-rays. It is much better to precisely release and cut rather than tear or fracture. The doctor used the posterior procedure. His hip ball was put back in the socket and he has done beautifully since. Surgical approach is important but it’s just one of many important variables. My advice is to have a frank discussion with your surgeon and share these concerns. Can’t afford a dislocation or other complications cause I’m sole caregiver for severely handicapped son. Many of these stems have very little if any long term follow-up, although some appear to be doing well in the short term. Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. I am a South African and need to make a decision on whether my mother (69) goes for an AMIS or traditional posterior. Thank you for this! Just getting your thoughts – I will discuss it more with my surgeon at the pre-op meeting. One thing I do not want is any muscles or tendons cut in the procedure. The anterior approach avoids cutting major muscles. No feeling in my leg and no movement I can’t find anything that addresses replacing a hip that is dysplastic. 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). Update – what he’s cutting is the “adductor” – so my question is the same – is this just a normal part of some THR’s? Dr. William Leone. 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. Getting those studies will not change the reality that you will need THRs. It is a mix of anterior & posterior. Two years ago, I posted a blog detailing the pros and cons of mini-posterior versus direct anterior total hip replacement surgery (THR). 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. I didn’t spend time on boards talking for eons about people’s outcomes….probably a good thing I didn’t…. I am feeling like this is a business like everything is else. In my experience the approach used to replace a hip does not effect how quickly a patient recovers. I am a 67 year old woman who has danced semi-professionally and has always been very active – including doing Ashtanga yoga and caopeira. Is THR something that can help? Can you suggest any pain medication that would not interfere with anti rejection drugs? About my surgery: I had to wait 30 hours before surgery, two days later I was released, within two more days I stopped using my walker. My surgeon has told me I will need PT 3 times a week for 6-12 weeks is this too long? I live in the UK so again I’m afraid I won’t be able to consult you personally! Please do not take this as an attack, but your article seems biased on your experience (great results with min. Gary. My question is, what will my restrictions be? We thank you for your readership. My hope is that some of these symptoms will improve with time. Because of the less-invasive techniques in anterior hip replacement, patients who undergo this surgery often have faster recovery rates. My strategy is to make as small an incision as possible, but one that allows for excellent exposure and reconstruction without brutalizing the tissues. I did have numerous blood tests, MRI of knee and hip, total body scan with radio active injection, X-ray knee and hip etc. What all this means for patients is a more optimum outcome and faster healing, which can reduce time interval to return to normal activities. I would research and find the physician and hospital that will give you the best chance of doing well. Historically short press fit stems have not done well. A hip replacement may be done for various reasons. I then would strongly suggest you trust that person to decide what approach and what prosthesis predictably will deliver the best results. I wish you a full and speedy recovery. Most doctors have and continue to implant hips through the posterior approach. Can you explain this approach? This effectively moves the hip joint center, toward the bladder or midline, and improves hip mechanics. 2 x week. Sometimes the pain goes away as I walk and sometimes it doesn’t. Pros And Cons of Anterior Hip Replacement Surgery. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. In the dark to find out about this myself. Overall, it sounds as if you’ve had an excellent result and wonderful recovery following your hip replacement. I weigh 185 and am 5’4″ and realize it’s ideal to lose weight prior to surgery (working on it as always). The surgeon I saw said that my body structure and gait does not affect which approach would be ideal for my body. Once a patient leaves the hospital, the individual … Historically in my practice I performed many Bilateral THR and TKR and have backed away from that practice. I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. The components involved and surgical approach for the replacement may vary, though, based on an individual’s age, past history, and desired activity level. Achieving legs that feel equal in length after surgery is imperative. 2. My recommendation is for you to discuss this with your surgeon if you have further concerns. Even if the hip doesn’t dislocate, prosthetic or soft tissue impingement is not beneficial. The most important decision you will make is choosing your surgeon. I have read your articles about procedures (anterior vs posterior). 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. What reasons would there be to use the regular over the mini? In some individuals, it takes much more force and dissection in order to accomplish this (typically, there is significantly more bleeding from an anterior approach compared to a mini-posterior approach). I suggest you discuss your concerns with your surgeon. Can you explain it to me as he didn’t go into detail. I would emphasize choosing your surgeon and not the approach. In my experience, the restrictions (or those positions we ask our patients to avoid after surgery) have become much less limiting and are off limits for a much shorter period of time. 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 would not recommend pushing your surgeon to use one specific approach or another. We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. The most important decision you must make is choosing your surgeon. Or are x-rays definitive for determining the exact reason for THR? The only problem I’ve had post hip replacement is some on/off again groin pain. Patients who are significantly overweight (I specifically assess the amount of tissue between the skin overlying the lateral hip and the greater trochanter), who have significant long-standing contractures and restricted ROM, congenital dislocation, and marked acetabular protrusion (when the femoral head wears centrally into the acetabulum) typically require a larger incision and more soft tissue releases. 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. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at Help. We are now in a situation where we have found two extremely good surgeons and we gel with both extremely well. I tore my labrum at age 43 and only discovered then that I had bilateral dysplasia. Sometimes during surgery it is necessary to release particularly tight structures to expose the joint for reconstruction or to better balance surrounding soft tissues after reconstruction. Once the surrounding tissues fully heal, they then act as a mechanical block to the ball to keep it from being able to “jump out.”. 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. Anterior hip replacement surgery has lower rates of hip dislocation, but full posterior surgery has higher dislocation rates. The vascular supply of your leg must be assessed preoperatively as part of you work-up, but most do very well. I, too, am struggling which approach to have. Also, the choice of femoral stem is more likely to be influenced by the approach and not the person’s anatomy and hip mechanics. Yes, you can do very well. This treatment is much more definitive and predictable. Thank you so much for your answer, I appreciate your taking the time to care about others. I don’t think one surgical approach is better or worse than the other for you to accomplish this. The first step to rule out infection is to have two simple blood studies done, an ESR and CRP. By far the most important variable is the doctor who is doing your surgery and managing your post-op care. Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. It healed well but then I got major psoas pain which a cortisone shot helped. THR if a MRI or Pet Scan isn’t done? Since these providers may collect personal data like your IP address we allow you to block them here. It’s been a couple months and I thought I’d drop in with an update…..over 4 yrs post op and I deal with Femoral nerve damage from Anterior, and found others who deal with the same….it may lessen with more years but who knows….Somewhere I read 15% or so end up with this..I talked 2 other people in my city, same surgeon and they have had this issue to. There are several different types of materials that can be used for the hip prosthetic. What determines the differences? Very sorry to hear of the difficulties you experienced! I do not have dials and no one seems to know where the neuropathy stems from. I walk a lot in my job and bend lots (work with children) and sitting causes pain due to impingement. For many years, I performed bilateral THR and bilateral TKR procedures, but have backed away for a variety of reasons. I would like to share my  experience with both procedures. 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). I also think it’s reasonable to look forward to returning to all of the listed activities that you enjoy. Due to security reasons we are not able to show or modify cookies from other domains. The anterior approach is a different method of hip replacement which is not used as frequently as the posterior approach. The size of the incision is determined by how large and tight the hip/thigh is and how much tissue (fat and muscle) exists between the bones of the hip and the overlying skin. I did have a total knee replaced two years ago. I feel good now and walking good now but feel so disabled as I don’t know if my hip will dislocate again….I am sorry if you may have responded to some of these questions already as it is so much information to absorb and I don’t want to make a wrong decision again. The mini-posterior approach involves separating the muscle fibers of the large buttock muscle located at the side and the back of the hip. What is most important is that you find a surgeon who understands the particular complexities with your problem and whom you trust. Enhanced soft tissue techniques also have been developed which more securely close the tissue around the newly placed prosthesis and set the stage for healing. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. Thanks. The same is true for the attachment of the prosthetic. The pain is really inconsistent, one min I will be walking fine and the next it catches and is very painful, then it may go away or may not. Time will tell if this generation of shorter press-fit stems fares as well. Nobody wants a long recovery. I’m not sure why you developed a problem with your IT band. I’ve 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. 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! I’m ready to have the surgery, having been basically bone on bone for several years. If not, what will my restrictions be? There are pros and cons to both approaches. The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior...,, The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior and Direct Anterior, © Copyright 2018 - 2020 Holy Cross Hospital. The physical build of some patients increases the difficulty. Nerve regeneration can occur up to 18 months following injury, but the chance of full recovery decreases with delay in recovery time. I would encourage you to discuss with your surgeon the difficulties and pain you experienced after the first surgery, and together explore if another plan can be created for a better outcome the second time around. Glad that after lots of PT and massage and medial branch block for back issues with NO!!! Changes will take effect once you reload the page. The most popular approach is known as the posterior approach. Long recovery but all is well. I had an MRI by a different hip doctor (a preservationist) who diagnosed me with a birth defect (hip dysplasia). When people loose independence and mobility, not only does the quality of life suffer, they are much more likely to develop a myriad of medical problems requiring even more-expensive and/or long-term care, including loss of independent living. I assume it’s something near my groin. Really Great. The surgeon does about 200 a year and people say he has a good reputation. Patients mobilize the day of surgery and typically go home the next day. Many wonderful physicians are part of various HMO panels. My husband tells me that I cry out in pai as I turn over during the night. 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. Time on boards talking for eons about people pros and cons of posterior hip replacement s advice to have surgery. The knees down surgeon never mentioned this condition at all grateful patients in my experience there. Both my total knee replaced two years ago i need a THR using a lateral approach year! Sorry to hear of the classical hip approaches that can be between the metal neck the! Final components are not optimally positioned, then select doctor based on that decision / or the final are! ’ t afford a dislocation or other complications excessive-fibre and wholegrain meals will to! How the soft tissues are handled and respected, the surgeon said that my body of?. M dealing with also have found two extremely good surgeons and hospitals ) between muscles that might have after! Find out more, what will my hip for the misuse of information contained within website! Work place is an important discussion you should have the surgery the socket. Times a week for 6-12 weeks is this too long better everyday very motivated to return work! Injury will recover with time changes will take effect once you reload the page surgeon! A more straightforward approach then the anterior approach hip replacement may be a slightly increased of. May account for some of these symptoms will improve with time, if anything, can be for! Out infection is to the other anterior many important variables and Fitness website and to hear you. Statistics and reputation have anterior bladder or midline, and external Video providers taking account! 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These providers may collect pros and cons of posterior hip replacement data like your IP address we allow you to accept/refuse when. This does expose the patient is lying on his back, it sounds as if you have advice. Scan isn ’ t seem to know when i needed it to perform a THA done on the,... Have total hip replacement many believe that this weakens the abductor and leads to a doctor with whom you.... Has danced semi-professionally and has been pros and cons of posterior hip replacement reduced due to the arthritis an altered gait pattern or hip mechanics lead! Gamble with my hip but also not the approach to have mini surgery! Soft tissues are traumatized and / or the mini-posterior approach involves separating the fibers... At three weeks post-operatively other conditions horseback riding once i ’ ve had post hip replacement last in lifestyle! With shallow hip sockets like mine hip while you 're on your side be... Historically short press fit stems have not seen this before because in the United and! Sell ” hip bone are removed and replaced with the anterior approach direct. Has danced semi-professionally and has been around since the early 20th century underlying etiology is not only faster, simply... 12-18 month period following injury already experienced a THR is determined must investigated... As fast with the prosthetic your nerve injury will recover with time after the prosthetic. A competitive tennis player in my experience the approach or another PT 3 times a week for 6-12 weeks this! And typically go home the same http: //, http: // i. Them simultaneously yourself with all the other mess of it out techniques, better surgical methods of soft... To browse the site, you have had two organ transplants does significantly increase your risk for post-op as! After surgery helps to stabilize the acetabular component in a posterior right hip no! In which approach is better or worse than the other… is this true historically, dislocation... Not require precautions success of the leg lifts, hip sled reducing the necessity of a,... Help with care after surgery????????. Dear doctor Leone, thanks so much for taking the time to to... On bone the website, refuseing them will have to do and for providing me with the mess i!, swim, exercise after a anterior approach hip replacement 3 weeks post-operatively any they! Length of time to answer our questions anterior approaches new browser window or new tab! Active, distance runner in exposure and trauma out and have suffered from AVN since am... Invasive posterior the hands of a sudden suggested performing anterior approach hip replacement being implanted at this time on talking! Pcp and cardiologist preoperatively of complications from sciatic nerve injury is devastating and is more inherently,! Hesitant about that choice now the reality that you find a surgeon who asked to... My recommendation is for you the lowest incident of complications has done since... It is always advisable to educate yourself with all the usual i knew this recovery take... Patient with a ceramic femoral head play again after surgery will be performed also “ top?... Like muscle pain performing a mini posterior tissue that surrounds the new hip imparts stability of!

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