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. It is critical to make the right decision regarding anterior hip replacement surgery in each case. 4. United States. I believe a THR will benefit you tremendously. I am deciding that my quality of life is in the toilet and need to get the THR done. But Im impressed with your blog and responses, so am writing to ask you about an apparently new procedure in which the surgeon uses a customised implant, utilising pre-operative 3D CT scanning. I think there may be increased associated complications. 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. How long will my hip replacement last? I am a 49-year-old female. No feeling in my leg and no movement Although Superpath hip replacement is often a safe treatment, it may be associated with certain concerns, such as increased postoperative pain, as with any surgical procedure. When done well, your body does well with this technology. Have you heard of something like this, and if so, is it worth it? Dr. William Leone. Im not sure why you developed a problem with your IT band. Having physio Therapy hopefully will help any contractures and scaring within your muscles that might have developed after surgery. OTC nerve supplements suggested by a naturopath. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. If possible, choose a hospital that specializes in joint replacement and can back that up with excellent statistics and reputation. Your back does need to be evaluated as well. Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. Over time, untreated hip dysplasia or hip impingement can lead to arthritis and, eventually, hip replacement surgery. 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. Should I be though? Most doctors have and continue to implant hips through the posterior approach. 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. 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. Otherwise you will be prompted again when opening a new browser window or new a tab. It also keeps the surrounding muscles and tendons in place to reduce the risk of post-op pain and nerve damage. Time will tell if this generation of shorter press-fit stems fares as well. If you do not have a hip replacement, you will live a sedentary lifestyle and become overweight. In 2010, more than 310,000 hip replacements were performed in the United States. You can do anything you want after a hip replacement. If this occurs, the patient usually requires a total hip replacement. I know the most important decision you will make is choosing the doctor who will perform your surgery. Pain modifying drugs as well and as a course of NSAIDs might also be appropriate. If I can put you on the spot. Thanks for any feedback. Choose your surgeon and not the approach or prosthesis. The new femoral prosthesis and new socket . But I am now in chronic low grade pain thats getting worse and dont know what I should do. The highly crossed linked polyethylene liners are now the gold standard in this country. After reading your blog Im thankful he suggested this approach. There is less risk of neurological injury. Thanks for giving us patients the kind of information we need to be more educated as to what questions to ask. (Of course, I do.) An anterior approach to hip replacement allows the surgeon to perform more limited views of the hip joint during the surgery, making the procedure technically challenging for less experienced surgeons. I think it was sensible being careful on the other hand and I was told not to cross my legs. I'm hoping to read some posts post surgery. Would you recommend treating plantar 1st? My recommendation is for you to discuss this with your surgeon if you have further concerns. About how much does this cost? When the stem is placed in the femur, it still destroys the same amount of bone for implantation, regardless of which approach is used. Because the patient is lying on his back during the procedure, fluoroscopy or moving x-rays are used to aid in the examination. Every prosthetic joint has a mechanical range of motion. Check to enable permanent hiding of message bar and refuse all cookies if you do not opt in. I very rarely transfuse any patients now. 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. Infection. My husband tells me that I cry out in pai as I turn over during the night. Understand that every total hip, no matter which approach is used to implant it, has the potential to dislocate. Ill know a lot more after we meet and I review your X-rays. Today, everything from tools to techniques has improved. Try our Symptom Checker Got any other symptoms? I am now 59, still in good condition but that is being compromised by lack of working out as my hips get sore from most everything I try. The surgical "approach" in total hip replacement describes the anatomical pathway and technique that the surgeon uses to access the hip joint to perform the surgery. Due to security reasons we are not able to show or modify cookies from other domains. But this will always prompt you to accept/refuse cookies when revisiting our site. I would also like to know about the customized implant, as I havent yet heard much about it. Dear Mary, I think the recovery time is the same though. The first step to rule out infection is to have two simple blood studies done, an ESR and CRP. Dear Dr. Leone, I have a good surgeon (same one as last time) but I dont know how he would feel about my asking if a mini posterior (or posterior) procedure be carried out, so as to preserve as much strength in my right leg as I now have.Do as many muscles need to be cut in the mini posterior procedure? The first surgeon never mentioned this condition at all. It was also observed to be associated with longer surgery times. This is not true for bilateral cases. My legs are very muscular and trim. Some patients report that symptoms increase in the not-yet reconstructed hip because of the leg length inequality. I wrote to you in January, now my surgery is in a couple of weeks. 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. Hip replacement currently consists of two major approaches: direct anterior and anterior approaches. Many people seek anterior hip replacement due to the unbearable pain they feel in their hip joints. 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). 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. I went with a total hip replacement. Thank you for all you do and for providing me with the information when I needed it. thank you for your time. When discussing the options, my surgeon all of a sudden suggested performing anterior approach. Both problems are on the right side of my body. It is critical that the patient is aware of the risks, benefits, and alternatives of the procedure. 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. The intended interval between the front thigh muscles can be difficult to recognize and there has been an associated increase in injury to the femoral nerve or vessels. I think they are happier and rehab more quickly. I have dealt with my hip pain and limping for over a year, can no longer perform my daily activities, and cannot sleep well anymore. A hip replacement is an excellent option for people who suffer from significant pain and disability as a result of arthritis in the hip joint. No Muscles Cut is for billboards. Patient Concerns A hip replacement is the most common cause of complication in about 20% of cases. Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. I have seen 4 surgeons. The impingement can be between the metal neck of the stem and edge of the cup or between soft tissues. (PATH) and Supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty: learning curves and early outcomes. Historically short press fit stems have not done well. Granted I do deal with lower back OA and right knee OA and now all worse and now foot/ankle mess, all on right hip side. We now have less-invasive techniques, better surgical methods of closing soft the tissue and more experience. Im getting close to needing my left hip done. In Dr. Lawrence Dorrs opinion, doctors and hospitals should not market a specific type of surgery as the most effective. Ultimately, you and your surgeon should discuss all procedures and technologies available and then trust that your surgeon will choose the best course of treatment and surgical procedure for you. In my last blog post, I discussed minimally invasive surgery with regard to hip replacement. Return to the work place is an individual decision. 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. Help. Your surgeon will know better than anyone else just how stable your new hip is immediately after your surgery and how securely the surrounding tissues were repaired after the reconstruction. The first is that it is a major surgery, so there is a risk of complications such as infection. I am so sorry to learn that you have had such a bad experience after THR. Finally, in July 2013, the first SuperPATH Hip replacement in Australia was performed in Nepean Private Hospital, Sydney. Soft tissue contractures often are associated with long-standing arthritis. The second most-common injury is to the femoral nerve. I would rather my patient get half as much anesthesia. That's all I know. A THR is in my future. With SuperPath, there is no surgical dislocation of the hip. More likely, its because ones activity increases after the first THR. This technique avoids cutting muscles and tendons, minimizing surgical trauma and improving the post-operative experience. I would discuss fully your goals and concerns. Each is safe, effective, and capable of delivering exceptional results. Both approaches have been shown to have potential in research. It does mean the surgeon has lots of room to move about though!! Many times, the depth of the destruction that is found during surgery is much more advanced than initially anticipated, particularly as we age. We have to get ok from cardiologist and get ekg, chest xray, etc. Dr. Sigmund holds a subspecialty certificate in Orthopedic Sports Medicine. As a result, you are unable to pick up something from the floor or bend down to tie your shoes. I feel good now and walking good now but feel so disabled as I dont 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 dont want to make a wrong decision again. I am female and I weigh 115 pounds. With the ease of movements during pregnancy, you will be able to move around more freely. I have two questions one, how realistic would it be to try to have both hips done at the same time? Less tissue damage during surgery allows for a much faster recovery and no restrictions in range of motion when compared to traditional hip surgery. An artificial joint is used to replace the worn out hip joint during a hip replacement procedure known as posterior hip replacement. There are many effective approaches and techniques that allow implantation of a total hip. 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. I had a posterior, the surgeon did not cut any muscle, they just move them now. Further, rehab after hip arthroscopy often requires partial weight bearing on the operative side and that would be difficult with newly operated THR on contralateral side. 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. This suggests that something changed after five months. Should one of these events occur during a mini-posterior procedure, they are easier to recognize and correct. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. Just getting your thoughts I will discuss it more with my surgeon at the pre-op meeting. Many, many interactions and decisions go into the final result as well as someones perception of his or her result and experience. I recently had a spontaneous hip fx and was diagnosed with hip displasia. The same is true for a surgeon who employs the anterior or anterior technique. It sounds like he did fabulous job. Ill be 60 at the time and Im 54 and weight about 130 lbs in fairly good shape. 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. If you would like a personal consultation, please contact our office at 954-489-4584 or by email at LeoneCenter@Holy-cross.com. Currently we use standard ways, called either posterior or direct lateral approach. It normally takes about 3-6 weeks to resume normal household activities and about 12 weeks to resume recreational activities like bicycling or golfing. The bone isn't dislocated in surgery. But I feel that time could be lost and all my symptoms may become irreversible. I ride horses, water ski and kayak. Usually a hip problem is addressed before a knee or foot problem because by solving the hip problem first, the knee or foot often improves if the pain is referred from the hip (more common with knee pain) or if by addressing the hip, the body mechanics and the fluidity of gait improve. Mine certainly have. The bone isn't dislocated in surgery. Yes, you can do very well. I believe going home is very therapeutic and often safer. The anterior approach has a lower incidence of sciatic nerve injury and a higher incidence of femoral nerve injury. What are the experiences of other countries with THR? Other conditions, to which you alluded, such as having a back condition and an arthritic knee and foot, all can masquerade what the real or most debilitating problem is. The femoral prosthesis is inserted into the hollow part of the femoral shaft. Im 51, 59 and 148 and want to get back to tennis etc, this has been long frustrating process. 2012 Oct 17;94(20):1897-905. doi: 10.2106/JBJS.K . If your X-rays reveal that you already have bone on bone due to osteoarthritis, then you typically dont need either an MRI or Pet Scan, unless another diagnosis is suspected. Here are a few of the advantages of anterior hip replacement. Also, the surgeon said that I would end up having one leg shorter than the other is this true? Better luck to you all. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. Thank you. There is a possibility that blood loss may be reduced as there is less unnecessary exposed bone surface left to bleed. You can resume your active lifestyle as soon as possible thanks to a new prosthetic hip. 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. Is a prerequisite for THR to have a MRI or Pet Scan? We thank you for your readership. Testimonials In the hands of a master, all can produce wonderful and predictable results. If you have an abnormal anatomy or are morbidly obese, you may not be a good candidate. It is 100 percent normal and expected to be scared before surgery. The anterior approach, as a marketing tool, has grown in popularity among surgeons. This is used when the cartilage in the hip is severely damaged by osteoarthritis or other conditions. July played my last match when I buckled. There is a more than 200% chance of knee infection, most likely because the knee has more surfaces that can become infected with an infection. 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 . With mild dysplasia, positioning and implanting the new cup usually is not more difficult than with other conditions. Everyone I know that has had both posterior and anterior surgery say not to even consider posterior. Dr. I think it perfectly ok to discuss different approaches and ask for an opinion. Your symptoms still sound mechanical, positional and episodic. Posted Even a task as simple as putting on socks and shoes can result in debilitating discomfort when a severely damaged or arthritic hip is involved. Many wonderful physicians are part of various HMO panels. When asking a prospective surgeon about the anterior vs posterior approach he told me that it is necessary to use a smaller prosthesis which would not be as stable with the anterior approach and did not recommend it for this reason. I do not want the approach to dictate the optimal construct which I hope will last 20 years and more.