";s:4:"text";s:25658:"Unfortunately, injury to the lateral femoral cutaneous nerve is a common complication after the anterior approach for hip replacement. 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! Total hip replacement is one of the most successful operations ever developed and is a remarkably predictable way to relieve pain from arthritic conditions. Rather, they say Bill, please just do what you have to do and do a great job. Click to enable/disable _ga - Google Analytics Cookie. Does this mean my body may reject the metal of the post or cup? It is critical that the patient is aware of the risks, benefits, and alternatives of the procedure. Thank you. If was 3 weeks after discharge I am a 73 year old woman who has been having severe hip pain for the last seven months. I would anticipate that you would be able to return fully to your activity once the tissues around your total hip heel. With a significant learning curve, it is likely that you will have to replace about 100 hips before you are truly comfortable with the approach. Most patients are able to walk the day of surgery. The mini posterior approach works wonderfully and predictably when expertly performed. Therapy hopefully will help any contractures and scaring within your muscles that might have developed after surgery. Click to enable/disable essential site cookies. When discussing the options, my surgeon all of a sudden suggested performing anterior approach. Patients are typi. One thing I do not want is any muscles or tendons cut in the procedure. Disadvantages of the anterior approach include: Although I am trained in both approaches and have trained surgeons in both approaches, I have stopped using the anterior approach because I saw my patients get well faster, bleed less, and have a more predictable result when I performed the surgery using a mini-posterior approach. This does expose the patient to more radiation but can help with component positioning and sizing. I have linked back to several blog posts below that will give you more in-depth information. The surgical area of anterior hip replacement is located in the vicinity of the lateral cutaneous femoral nerve. disadvantages of superpath hip replacement. Femoral nerve function also should be assessed. This often leads to a less than optimal component position. If you were in Los Angeles and needed a THR who would you choose to do your surgery? Call (919) 781-5600 to find out if you need total shoulder replacement in Raleigh, Cary, North Raleigh, Garner, or Holly Springs. Hello Dr Leone, When studying the hospital credentials, try and learn how many joint replacements are performed at that hospital each year, their infection rate and their 30-day readmission rate. Until now. It's a hip replacement surgery where you lie on your side. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. I wish your patient well. I would discuss fully your goals and concerns. I am scheduled for total hip replacement in about 3 weeks, and none of these procedures/options were discussed with me.the surgeon just said that it was a risky surgery and he could not guarantee anything! When the anterior approach is used, the soft tissues in the hip stay intact, allowing for better hip alignment. Most of the restrictions are removed at that time, although I still advise common sense, particularly for the first three or four months. So im going back to the surgeon that did my left hip and left me in agonizing pain for 2 months after procedure. I have been told that I can fly 48 hours after surgery?? When a dysplasic hip is reconstructed to THR, its important the abnormal mechanics are corrected, typically by medializing (closer to the midpoint of the body or bladder) the cup. Nerve regeneration can occur up to 18 months following injury, but the chance of full recovery decreases with delay in recovery time. I ask my patients to restrict certain positions that exceed the mechanical limits of the artificial hip for the first six weeks. I still have a very big limp and still undergoing physical therapy. In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. I am experiencing pai. Ive never foulnd information from any doctor or research-site but that there is always no legs-crossing, no more than 90-degrees (for the most part), and no twisting for anything but full Anterior. 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. I am very athletic and active even with many years of pain from bone on bone arthritis so I am worried about restrictions since Ill probably forget or something. There tends to be a lesser incidence of posterior instability with the anterior approach. My acyive 60 year old husband is scheduled to have Mini posterior total hip replacement in 6 weeks. I would love to hear some stories about the SuperPath hip replacement. Going in for THR in July. Ultimately, it is important to discuss all of the available options with your doctor to determine which method of hip replacement is best for you. In my 25 years of practice, the variable that seems to have changed the most is how quickly people recover from this surgery when done well. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. Dont let PR marketing confuse the big picture. I am so sorry to learn that you are struggling. Thank you so much for taking the time to inform us! Click to enable/disable Google Analytics tracking. 2004 Apr. Hard-on-hard bearings, such as ceramic-on-ceramic as well as metalon-metal articulations, also resulted in larger femoral heads being implanted. I choose to do them in a staged fashion because it is a significantly shorter procedure (more than half time-wise) and some think this lessens the risk of infection. 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.
The bone isn't dislocated in surgery. Over the last decade total hip replacements have been performed using 2 main approaches: The posterior approach in which the hip joint is approached from the back by releasing and reflecting the short external rotators and dividing the capsule at the back of the hip; and the anterolateral . Fortunately, you have already experienced a THR and have done well. If this occurs, the patient may experience pain and swelling. I dont know what type of procedure was used for my first op but it was sucessful and now can do a half lotus position with no problem.I do find however that the muscles at the front of that leg are not as strong as my unoperated right leg and lifting the left leg to a vertical position in yoga, when lying on my back, is quite difficult. When the joint is held together by gravity and asymmetric anterior muscle tension, the tension between the ball and socket may change in various directions. This can cause you persistent pain, stiffness . Some other methods are effective, but they are less effective for patients who leave the hospital earlier. The main limitation after surgery is a lack of comfort. Recognize that the underlying etiology is not being corrected by this procedure, so relief of symptoms probably will be temporary and possibly partial. 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. However disadvantages include the inability to adjust for leg length differences and a relatively high risk of femoral neck fracture. I am a competitive tennis player in my age division. OTC nerve supplements suggested by a naturopath. The surgeon I went to said he does THR using a lateral approach. If you do not want that we track your visit to our site you can disable tracking in your browser here: We also use different external services like Google Webfonts, Google Maps, and external Video providers. Patients who work for themselves are very motivated to return to work and often do so between procedures. The vascular supply of your leg must be assessed preoperatively as part of you work-up, but most do very well. I typically do hip replacement on the get anterior approach in 90% of my patients. We are always refining and trying to make it better. There are various ways of doing a hip replacement. That being said, you should have the additional surgery where you feel you will have the best chance of doing well. Dear Dr. Leone, I am having Makoplasty ( robotic imaging) to my right hip in February. I advise both my total hip and my total knee patients to avoid repetitive impact activities like distance running. 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. The SuperPATH technique is arguably the least invasive hip replacement technique. Also congenital pulmonary hypertension (PA pressure about 52) and have hashimotos hypothyroid, and two additional auto immune issues ( alopecia and psoriasis of feet),and hypertension. There is a chance that the hip will fall out of the socket, or that it will be levered out by twisting it. Lastly, where can I find a great surgeon that takes FL Workmans Comp? Problem is that we have seen two doctors and both seem great but are on two extreme sides of the fence. Dr. Leone, I am coming in to see you for an appointment for a THR to my left hip. According to Dr. Gililand, patients should not try to change their surgeons opinion based on their preferences. DAA and SuperPATH were equal in functional outcome and acetabular cup positioning. There are 5 questions, mobility, self-care, usual activities, pain and anxiety. The bigger the ball, the bigger the ROM without impingement and the bigger the jumping distance that would be required for the hip to dislocate. Felt very uninformed and left Also, when a single joint is replaced versus bilateral, there is significantly less bleeding and hence a much decreased need for transfusion. The anterior approach, as a marketing tool, has grown in popularity among surgeons. Very slow recovery. Thank you. When performing anterior anterior reconstruction, these patients frequently have very short stems that are inserted into the bone. 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. 2012 Oct 17;94(20):1897-905. doi: 10.2106/JBJS.K . Patients are told how to use their hip after hip replacement surgeries, which is very different than the usual practice. If you refuse cookies we will remove all set cookies in our domain. This allows you to resume normal daily activities quickly while also returning to normal range of motion and function. I will let you in on something personal. July played my last match when I buckled. Advantages of an anterior approach to hip replacement A major muscle is not cut during the anterior procedure. The activity that I wish to have the most success with after the surgery is ballroom dancing. 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. Also, in the U.S., nearly all stems which are being implanted through the anterior approach are press-fit rather than cemented. Contact Dr. Moor, Orthopedic Surgeon at Advanced Sports Medicine Center. In addition, patients prefer the anterior approach due to the absence of pressure on the Femoral nerve in the anterior approach. You are to be commended for taking the time to answer our questions. They are addictive, can cause depression, their analgesic effects are short lived and if the condition persists, you will require an increasingly higher dose to relieve the pain. The pain I get is in the groin and a sharp pain in the buttocks, that feels like muscle pain. From what Ive seen, most THR patients dont need very much PT, although I do encourage exercising in a pool. I wish you a full and speedy recovery. Stay was 2.5 days. It is important to consider the SuperpathTM technique if you are considering a hip replacement. Thank you for sharing. You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. If your little voice is questioning if you are overdoing it or hurting yourself, then listen to it and ease up. External rotation of your feet should be limited (avoiding them twisting to the outside as Charlie Chaplin does) and hip hyperextension should be avoided. J Orthop Surg Res. Pam. Most patients decide not to wait as long to have their contralateral hips or knees replaced after having undergone a successful surgery on the first side. I am about to have a hip replacement and would like to know what kind of limitations Ill have afterward. It would be interesting to hear what you have to say Doug. In a posterior hip replacement, the procedure is done on the side of the hip. You can check these in your browser security settings. 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. A THR is in my future. These are some of the most grateful patients in my practice. But I am now in chronic low grade pain thats getting worse and dont know what I should do. J Bone Joint Surg Am. I just saw a patient with a femoral neuropraxia after a anterior approach THR. Inpatient footage of the patient compilation has been edited out to accommodate hospital rules. Historically, higher dislocation rates were reported with the posterior approach, but it still was used for its many other advantages. Many in business or who own their own businesses will stay home for only one week and then return to their work place because they are bored and would rather be productive and busy. Because the patient is lying on his back during the procedure, fluoroscopy or moving x-rays are used to aid in the examination. Introduction. 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. Back to work/driving in 10 days. Many others feel the same. If a revision were necessary, even more bone must be destroyed to remove it. I was so against doing this surgery but groin pain was very bad and crushed bone in the groin. You can do anything you want after a hip replacement. Lastly, if one has had P or AL is there anything that can be done to offset the need for restricitons? An anterior hip replacement does not have any limitations based on comfort. So my question is in relation to my body structure. United States. Most of my patients now go home the day after their surgery or the next. I also would learn about the track record of the surgeon and hospital where you will decide to have the surgery and what implant will be used. Obese or extremely muscular people may not be the best candidates for this surgical procedure. More likely, its because ones activity increases after the first THR. Spring 2014 had trouble playing tennis, hip kept feeling like it was popping out of joint, groin pain, aching. Otherwise you will be prompted again when opening a new browser window or new a tab. Nobody wants a long recovery. It turned out to be more torn than they thought and they had to cut about a forth of it out. Pain and disability are reduced. My doctor does the Posterior approach, he didnt say anything about the mini part. Patients can also have as little as a 3-inch incision. I wish you a full recovery. I don't think there's a one size fits all when it comes to hip surgery. The pain in my hip is strange in that I can hike uphill and down hill, bike and X-country ski but have a very hard time walking on the flat, especially after sitting for awhile or getting out of bed. Everyone I know that has had both posterior and anterior surgery say not to even consider posterior. My problem isnt from a worn-down joint with no cartilage. I was really careful bending etc for four weeks until I saw the physio, who said "oh you could have touched your toes if you had wanted to!" I think seeing several surgeons for different opinions is good judgment. Fortunately, the incidence of hips dislocating after THR is very small, especially after first-time hip replacement. Conclusions SuperPATH approach showed better results in decreasing incision length and early pain intensity as well as improvement of short-term functional outcome. Should one of these events occur during a mini-posterior procedure, they are easier to recognize and correct. By far the most important variable is the doctor who is doing your surgery and managing your post-op care. You are free to opt out any time or opt in for other cookies to get a better experience. It will help desensitize and help get your muscles working in synchrony. Notes on SuperPath experiences good or bad, https://patient.info/forums/discuss/superpath-experiences-good-or-bad-718788. An anterior hip replacement is not covered by a specific credential system for orthopedic surgeons. The first surgeon never mentioned this condition at all. Full Function, Faster . If youre impressed by how clean it appears and the movement and professionalism of the staff, that obviously is a good sign. I had no inkling of this till he showed me on the x-ray. Results of the surgery numbness in the right thigh, inability to stand on the right leg, muscle atrophy all confirmed by EMG and second orthopedic surgeon. Not sure exactly what that means. This effectively moves the hip joint center, toward the bladder or midline, and improves hip mechanics. Excess weight causes a hip joint that has already been stressed to become more painful and disability-causing. Thanks for giving us patients the kind of information we need to be more educated as to what questions to ask. His hip ball was put back in the socket and he has done beautifully since. Mini posterior refers to the approach or tissue interval the surgeon uses to implant the Total Hip. Patients understand the risks that metal joints and sockets bring to their long-term health and are moving away from the material. I had a consult with a surgeon who does posterior and cuts muscle & tendons. It typically requires a 4 to 5 day hospital stay, 3 to 6 month recovery period . There is also a risk of the hip joint not fusing correctly, which can lead to pain and instability. I am a!so told by the orthopedist who referred me that I need arthroscope on my right hip. I was thinking of doing that 1st, maybe April(Ill be in boot 4 weeks), and then the PTHR in either Sept or next Jan when I have free time. This technique avoids cutting muscles and tendons, minimizing surgical trauma and improving the post-operative experience. I furniture surfed in the house and used a stick outside.I was hopeless with crutches, but I think it is recommended we should use them, particularly to ensure we don't get a limp and build our leg up properly. An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. I spoke in person to probably 4-5 of his success patients and went with hearing from them. I also have undiagnosed neuropathy in both legs from the knees down. Losing weight and strengthening your muscles pre-operatively will make surgery easier and greatly facilitate your rehab. A metal or plastic implant is used to replace a damaged or diseased hipbone. I am planning to have a THR this summer. I plan to retire from working full time June 2017 and am concerned about having appropriate insurance after that. There are hybrids of the surgey from what I can see. Others continue to follow traditional guidelines. Thanks, Today, everything from tools to techniques has improved. Can you please on the various points in the post and perhaps also elaborate on the last point. What, if anything, can be done to revive femoral nerve and get my thigh muscles back in normal? 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. Hip replacement surgery is less painful than arthritis or fracture-related pain. Its been six months since surgery, my operating doctor keeps feeding me with lets wait another month stuff. Dr. William Leone. I did have numerous blood tests, MRI of knee and hip, total body scan with radio active injection, X-ray knee and hip etc. There are many different quality implants (just like surgeons and hospitals). Did you have the surgery via Superpath method? Orthop Clin North Am. It is much better to precisely release and cut rather than tear or fracture. I suspect there is significant underlying osteoarthritis related to your labral pathology. It was also observed to be associated with longer surgery times. To have your other hip replaced through a different approach is a decision you need to make with your surgeon. I would encourage you to discuss your expected recuperation time and specific restrictions with your surgeon. Adductors refer to a group of muscles that insert into the medial (inner) upper femur and often become contracted with an arthritic hip. I would say that in terms of posterior total hip replacement, the procedure is better than the old gold standard, which I believe was performed after 7 years and almost 1000 anterior total hips. After awhile the screws started shifting and poking up under the skin and they removed them. [QxMD MEDLINE Link]. The SUPERPATH technique is a tissue-sparing procedure. Sometimes, when a surgeon is working too hard to reconstruct through a very small incision, the ends of the incision tear and the tissues are traumatized. SuperPath approach uses about a 3-inch incision at the side of . Walking is the best exercise. i had lateral posterior, my surgeon stopped doing anterior because he said it caused muscle problems moving them about and can also cause nerve damage, which is the main reason I did not want that approach. 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. Once again, it sounds as if you had a wonderful surgeon, which is the most important variable. Once it exceeds this ROM, impingement occurs. Thank you for sharing. Yes, you can do very well. 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. I, too, am struggling which approach to have. Click to enable/disable _gat_* - Google Analytics Cookie. For centers like Phoenix Spine and Joint that use a robot, there is . Clearly, he or she has earned your respect and confidence. I have been in pain for about a year and first though it was a back issue and it has limited my ability to stay as active as I would like. (Of course, I do.) Its reasonable to inquire about his or her experience using the Mako robot. What is SuperPath Hip Replacement? I am going to get evals from 3 docs. Which is the best? Tina, which procedure did you have? Total hip replacement is a step-by-step surgery to replace the hip socket and the ball at the top of the thighbone (femur). Does either procedure in this discussion present restrictions or advantages for this sort of movement? I did have a total knee replaced two years ago. I am about 5 6 and 185 lbs, age 58, he did not think the weight was an issues. 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. Please do not take this as an attack, but your article seems biased on your experience (great results with min. My husband tells me that I cry out in pai as I turn over during the night. as being in breach of those terms. Because my husband has circulation problems in his leg and vein removed for open heart surgery last yearhis surgeon recommended the Mini posterior surgery. The bone isn't dislocated in surgery. Advantages of this procedure include: The direct anterior approach involves dissecting between the natural intervals of the two main muscles located at the front of the hip and upper thigh. There are a number of different potential surgical approaches available for hip replacement, each with their own potential advantages and potential drawbacks. There are risks and recovery times associated with surgery. 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.. 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