As of 2020 only Dr. Leone is using the latest hip technique called the SPAIREtechnique where patients no longer have hip precautions after surgery. A less stringent set of precautions is required with the anterior approach. The leg lifts really aggravate the front of the hip. Are these expectations realistic? An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. No Muscles Cut is for billboards. I also regularly receive Rolfing treatments which has helped me manage pain and maintain what mobility I have. There are a few disadvantages to hip replacement surgery. Personally, I would not gamble with my health. We thank you for your readership. The surgeon does about 200 a year and people say he has a good reputation. According to Dr. Rosen, the most important thing to remember is what you leave behind rather than how you get there. This is used when the cartilage in the hip is severely damaged by osteoarthritis or other conditions. Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. Today, everything from tools to techniques has improved. 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 . 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. If not, what will my restrictions be? 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. 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. Most receive a simple spinal with sedation. 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. Thanks again! The SUPERPATH technique is a tissue-sparing procedure. Often in this group of patients, their X-rays show only minimal cartilage space compromise (it may appear thinned and irregular) and I observe at time of surgery that the labrum appears hypertrophied (to compensate for lack of head coverage) and often torn. Problem is that we have seen two doctors and both seem great but are on two extreme sides of the fence. emergent norm theory quizlet. [QxMD MEDLINE Link]. Once it exceeds this ROM, impingement occurs. Dr. William Leone. 4 mts later am using My surgeon wants to use the posterior approach and indicates that I eventually should be able to play golf again. I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. This is not true for bilateral cases. The mini-posterior is considered a more straightforward approach then the anterior, resulting in lesser complication rates. All: It exploits the same soft intervals but it typically accomplishes prosthetic implantation and soft tissue balancing through a smaller incision and, more importantly, with less underlying soft tissue dissection. Only Dr. Leone will be using the most recent hip technique known as the SPAIRE technique as of 2020. My two questions are: 1. Not putting you on the spot, but would it be advantageous for me to drive 200 miles to have a consultation done by you? My question is: should I just tolerate the pain and limp, or take a chance with the hip replacement. I think it perfectly ok to discuss different approaches and ask for an opinion. The art of surgery should mimic a well rehearsed ballet or symphony. It will help desensitize and help get your muscles working in synchrony. Fortunately, you have already experienced a THR and have done well. First, I am a little bit scared. Patients can also have as little as a 3-inch incision. The femoral nerve functions to extend the knee and also is responsible for sensations over the anterior and medial aspects of the thigh, medial shin, and arch of the foot. 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. Le has extensive experience in primary joint replacements, complex revision surgery, periprosthetic fractures, and infection management. Dear Dr. Leone, I suggest you discuss your concerns with your surgeon. My husband has a plastic valve (done in 86) and synthetic assending aorta and triple bypass (done in 2013)very successful surgery. This site uses cookies. The SUPERPATH technique is a tissue-sparing procedure which aims to get patients back on their feet within days (possibly hours) instead of weeks or months. Yes, Im angry. 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. Can you explain it to me as he didnt go into detail. I ask my patients to restrict certain positions that exceed the mechanical limits of the artificial hip for the first six weeks. Surgical approach is important but its just one of many important variables. Everyone I know that has had both posterior and anterior surgery say not to even consider posterior. The last page is asking the participant to self score their health that day out of 100. I dont know if this stems from the knee surgery but I do not believe so because I was well for about a year and a half. 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. Many people seek anterior hip replacement due to the unbearable pain they feel in their hip joints. I went with a total hip replacement. Raleighs orthopaedic clinic is board certified and has fellowship training in total joint replacement. My walking is very limited, shoe is built up as leg is shorter and in recent months Ive realized my leg is bowed. When a patient feels better, they can return to work almost immediately, though it usually takes two weeks or longer. We are now in a situation where we have found two extremely good surgeons and we gel with both extremely well. Clearly, yours was. However, there are also some potential drawbacks to this type of surgery including a longer surgery time, a greater risk of blood loss, and a higher risk of nerve injury. I have not seen this before because in the past, the complication from hip surgery were sciatic nerve injury from posterior approach. 1.2. If I have a 2nd revision of my right hip is it posterior approach or the mini-posterior approach as you discuss above? He is the founder and main author of brandonorthopedics.com, a website that offers valuable resources, tips, and advice for patients looking to learn more about orthopedic treatments and physiotherapy. That being said, I agree completely with your surgeons advice to have a total hip replacement and not a hip resurfacing. Yes, you can do very well. Remember, what youre hoping to do is have a hip construct that will last 20 years or more. Full Function, Faster . If a mini posterior approach is used and the resultant total hip has optimally positioned components and balanced soft tissues, and was implanted through a smaller incision with less underlying soft tissue dissection and trauma, then I believe it is a benefit. It sounds as if you had a wonderful surgeon. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. Cons of Robotic Assisted Surgery As with any type of procedure, Mako is not without its drawbacks. Im 51, 59 and 148 and want to get back to tennis etc, this has been long frustrating process. A major hip replacement can take up to four months to fully recover from. Other preoperative guidelines, such as using a prescribed pain medication and keeping the incision clean and dry, should also be followed by patients. I seem to be able to hike just fine up hill and down but not always on the flat. I would discuss fully your goals and concerns. I recently had a spontaneous hip fx and was diagnosed with hip displasia. I am 56 now and find that physical therapy and chiropractic care dont seem to be helping anymore. I advise both my total hip and my total knee patients to avoid repetitive impact activities like distance running. A hip replacement can greatly reduce the pain associated with arthritis of the hip, with almost all patients having complete or near-complete relief. What are your thoughts on the use of robotics? I am concerned that I may have a pinched nerve and that that is what is causing all this pai as the pain is severe only in certain positions but when I am tired I also have a throbbing pain in the sciatic region.talk about the golden yearsI thank you from the bottom of my heart for the kindness and caring that you do in answering all these questions. Over the years, these precautions and the length of time to adhere to these limits have been challenged both by clinicians and patients. If it is from intra-articular hip pathology such as osteoarthritis, which is very common especially in your age group, then most likely stem cell injections will not be affective and you would benefit from a total hip replacement. Seeing that a THR is considered major surgery, my question is, should I have my left hip done sooner than later to address the length difference or wait until I can no longer tolerate the pain? I have read your articles about procedures (anterior vs posterior). Adult patients who have a deteriorated hip may be candidates for total hip replacement. My advice would be to avoid the extremes of any motion that exceed your hips ROM. Depending on the stability and range of motion observed at time of surgery, some doctors dont advise their patients to avoid any positions. Im a very healthy long distance bicycle rider. This does not necessarily mean they will have more pain or take longer to get well. United States. Have you recovered by now? Femor fracture. The physical build of some patients increases the difficulty. Once again, it sounds as if you had a wonderful surgeon, which is the most important variable. I had a consult with a surgeon who does posterior and cuts muscle & tendons. I wish you the best of luck with your care. If you were in Los Angeles and needed a THR who would you choose to do your surgery? 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. Very sorry to hear of the difficulties you experienced! I am 37 and have suffered from AVN since I was 14. I walk a lot in my job and bend lots (work with children) and sitting causes pain due to impingement. 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. Pain Management My surgeon is doing posterior and my reason is I am self employed with limited Time off available and hope to be back to work at least walking and driving in 4 to 5 weeks is this possible? I have had both hips replaced about 13 months apart, one anterior and one posterior, and there is no doubt that I would recommend anterior. from publication: Current and . 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). In the United States, a traditional posterior approach is the most commonly used. Many of these stems have very little if any long term follow-up, although some appear to be doing well in the short term. With SuperPath, there is no surgical dislocation of the hip. This often leads to a less than optimal component position. You can resume your active lifestyle as soon as possible thanks to a new prosthetic hip. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. There are various ways of doing a hip replacement. We want the forums to be a useful resource for our users but it is important to remember that the forums are A ball and socket are used to connect the new joint to the thigh bone (femoral bone), which is made of metal, plastic, and ceramic. Finally, because my patients are walking the day of surgery, most want to go home rather than to rehab. more nutritious, too. A hospital outpatient surgery can cost between one-third and one-half the cost of an outpatient surgery atCOSC. Fortunately you live in a part of the world where there are many capable orthopedic surgeons. This is because the nerve is located in front of the hip. 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. External rotation of your feet should be limited (avoiding them twisting to the outside as Charlie Chaplin does) and hip hyperextension should be avoided. I am a 70 yr old female with a 4grade thickness loss at acetabulum and head of femur. Its been a nightmare for me going into 4 yrs post op soon. The big difference in anterior vs posterior hip replacement is primarily where the incision is made and how long it is. I would look at the published track record of the hospital where the surgery is scheduled to be sure its performance record is good and its incidence of infection is low. Both approaches have been shown to have potential in research. Should I be though? Sitting seems to irritate it the most. Really Great. I am so sorry to learn that you are struggling. 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. Still going to rehab to reduce stiffness and increase strength but I am in better shape now than before surgery. I am still a very active 67 yr old, I like to ski, bike, hike (steep terrain) with about 25 pds. Lateral femoral cutaneous nerve injury is the most common injury incurred during an anterior approach. This treatment is much more definitive and predictable. As you can see, there are no restrictions. What is most important is choosing your surgeon. The same is true for a surgeon who employs the anterior or anterior technique. I never seem to know when I am going to get hit with pain. Patient Resources According to the meta-analysis, DAA (depressing the anterior hip joint by using a metal rod) is associated with significantly shorter hospitalizations than lateral approaches, as well as increased functional rehabilitation and lower perceived pain during the first few days after surgery. 10 users are following. My surgeon uses the posterior approach. Personally, it I were caring for you, I would have advised you exactly as the orthopedic surgeon who took care of you did. 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. Soft tissue contractures often are associated with long-standing arthritis. What to Expect Risks associated with hip replacement surgery can include: Blood clots. I again suggest you concentrate on finding a surgeon in whom you have faith and then trust that doctor. Does either procedure in this discussion present restrictions or advantages for this sort of movement? Some other methods are effective, but they are less effective for patients who leave the hospital earlier. The impingement can lead to a levering out of the ball from the socket. More likely, its because ones activity increases after the first THR. Since these providers may collect personal data like your IP address we allow you to block them here. 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. It's cut off and removed through the hole. 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. I would rather see my patients go home. 2 x week. I had my hip scoped which bought me 8 years, but need a THR now. The development of a complete and secure surrounding scar tissue wall or pseudo capsule is critical for stability. If was 3 weeks after discharge out the next afternoon and using a walking stick from day 2 to day 10 when I ditched it altogether . Following surgery, the surgeon will devise a routine for the patient to engage in that is both comfortable and safe. For the prevention, diagnosis, and treatment of hip pain and other problems affecting your hips, call Advanced Sports Medicine Center today at (941) 957-1500. It seems, however, that at this time point, patients who have received resurfacings do as well or better than similar patients who have received total hip replacements. The idea is it should be a little less painful if the muscle, tendons and nerves are not disturbed. What is SuperPath hip replacement? Pam. I dont think one surgical approach is better or worse than the other for you to accomplish this. For centers like Phoenix Spine and Joint that use a robot, there is . I live in the UK so again Im afraid I wont be able to consult you personally! Before proceeding, it is a good idea to review the recommendations and specific parts that your surgeon may recommend. All orthopaedic surgery demands a long recovery period. I wish you only the best, Click to enable/disable _ga - Google Analytics Cookie. Im considering this mini posterior approach. Can you compare/contrast to the other approaches; posterior, mini posterior, anterior? I am a competitive tennis player in my age division. My doctor does the Posterior approach, he didnt say anything about the mini part. disadvantages of superpath hip replacement. I will reiterate what I know to be true. Your symptoms still sound mechanical, positional and episodic. Dear Mary, 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. At the end of the day, I promise, it is not the approach but rather the person who is doing the surgery. It is important that these medical and cardiac conditions be optimized by your PCP and cardiologist preoperatively. In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. Stay was 2.5 days. Diagnosed possible labral tear. Thanks. I am a 73 year old woman who has been having severe hip pain for the last seven months. I am a 53 year old active, distance runner. Typically, the new cup will be medialized to gain coverage and correct the abnormality that lead to your arthritis. I have seen a number of patients who were reconstructed with the anterior approach who developed painful anterior scarring after the procedure. There are a number of different potential surgical approaches available for hip replacement, each with their own potential advantages and potential drawbacks. Our insurance covers both. After reading your article on disadvantages of anterior approach and also doing extensive online search about this subject, I came to realize that anterior approach was definitely a wrong choice considering my physical build short, muscular, overweight. Two which are receiving the most attention are the traditional posterior approach and the direct anterior approach. Third, the procedure is shorter in length and requires less hospital stay than traditional hip replacement surgery. Do you have any advice or ballroom dancer THR stories to share? Before my hip problems, I really enjoyed playing golf and would like like to play again after surgery. 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 am going to get evals from 3 docs. What is most important is that you find a surgeon who understands the particular complexities with your problem and whom you trust. My gait is off partially due to my hip but also I believe because of my body structure. I believe a THR will benefit you tremendously. People undergoing traditional hip replacement surgery, for example, are advised not to bend at the hip more than 90 degrees for approximately six weeks after the procedure. Surgical Techniques Finally, hip replacement surgery is expensive and may not be covered by insurance. Do either of your techniques require the traditional anterior or posterior precautions? There are 5 questions, mobility, self-care, usual activities, pain and anxiety. There is no way that you can recover fast from having bones cut and shaped and large metal objects inserted into them. Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. The size and placement of the incisions will be different. Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. Changes will take effect once you reload the page. Felt very uninformed and left You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. Contact Dr. Moor, Orthopedic Surgeon at Advanced Sports Medicine Center. SuperPath hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons. Consuming excessive-fibre and wholegrain meals will assist to keep you feeling full, and will be Iliotibial (IT band) damage, had 2 months of ART release work on this issue. Thank you so much for your answer, I appreciate your taking the time to care about others. In comparison to traditional methods, anterior approaches to the hip joint are more effective. There are hybrids of the surgey from what I can see. As of 2020 only Dr. Leone is using the latest hip technique called the. In general, people who are older, heavier, or more active may not be good candidates for this type of surgery. I began using the superior approach for total hip replacement in February of 2014. . If possible, choose a hospital that specializes in joint replacement and can back that up with excellent statistics and reputation. Click to enable/disable _gat_* - Google Analytics Cookie. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com. It is critical to consider the pros and cons of each option before making a decision. SuperPath hip approach. 2021 May 20;16(1):324 . I dont want a long recovery time as I am very active. If possible, speak with other health professionals who work at the hospital or at least in the same geographical area. Other jobs, which tend to be more structured and / or more physical, may require more time off. Because my husband has circulation problems in his leg and vein removed for open heart surgery last yearhis surgeon recommended the Mini posterior surgery. General comments will be answered in as timely a manner as possible, Hip & Knee Surgery Over time, untreated hip dysplasia or hip impingement can lead to arthritis and, eventually, hip replacement surgery. I am Australian so no business from me but it has helped me become happier with my prospective surgeons judgement that he will offer me a posterior THR (hopefully the minimally invasive) when my insurance allows the procedure to occur. It helps the surgeon implant the acetabular component in a very precise position. Not wanting to go through all the restrictions, I was considering anterior for my right hip, which would require not having it done locally since doctors here have been doing it for only 1 year. Orthop Clin North Am. I have never operated on another surgeon who asked me to make as small an incision as possible or use the minimally invasive approach. I am terrified of nerve damage as I am very athletic and a previous professional ballet dancer. The incision made for the operation can be as small as three inches. Intervals between muscles are separated or muscles are separated in line with their fibers without injuring the muscles innervation. 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. Many also mate this with a ceramic femoral head. Hip replacement surgery is less painful than arthritis or fracture-related pain. Optimal component positioning also is critically important for the best stability and longevity. Many wonderful physicians are part of various HMO panels. 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. My first bike ride was 22 miles without any problems. SuperPath approach is the least invasive due in part to the minimal amount of tissue damage. Can I make an appointment with you. I take care of many individuals who have a total knee and hip replacements on the same side. Thru X-rays Ive been told both hips are bone on bone! Every surgery should be done with as minimally invasive approach as possible taking into account these other critical factors. Thank you. 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. Introduction How would a hip replacement be done? Mini posterior refers to the approach or tissue interval the surgeon uses to implant the Total Hip. The anterior hip can be easily and naturally recovered by walking, simple home exercises, and isometric exercises. Choose your surgeon. Some hospitals and surgery centers are promoting one method of hip replacement over another. Also there are concerns about disruption of blood supply to femoral head with this operation. I read about this type of mini hip replacement being done in the UK and just wondering if mini hip replacement means the same thing in the US . What has changed the most in my career, once again in a very positive way, is how quickly patients start walking (day of surgery), and go home and return to their active lives after THR, as compared with just a few years ago. 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. I prefer reconstructing the most symptomatic side first. Typically, most are eager to go home the very next day; many have already progressed to a cane, which they will not use very long. But this blog was a nice nudge toward the posterior. In bed for long periods with little or no movement. invasive posterior vs not so good with AMIS) whilst on the other hand, with one of your replies you state that surgeon experience should be considered with AMIS success rates and in other replies stating that both alternatives are good. A THR is in my future. Prior to surgery, you need to be evaluated by your primary care doctor and any other specialist who helps manage your care, so the conditions you have can be optimized. If I can put you on the spot. After the direct anterior approach, there is generally no hip precautions required, and motion is not restricted. Because the muscle fibers are separated, not cut, the nerve path is not disturbed and the muscle is not injured. Losing weight and strengthening your muscles pre-operatively will make surgery easier and greatly facilitate your rehab. I think the money you spend to have a hip replacement is more than just moral or justified, it is smart business. After all, no matter the age, it will determine the likelihood of maintaining your mobility and independence.
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