pros and cons of posterior hip replacement

Posterior or Anterior? 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. With wear and tear, broken bones, and various problems with blood supply that can occur at the hip, there will always be a need for some type of procedure like this. Also, because technically it is easier, many patients are being reconstructed with very short stems which are press fit into the bone during an anterior approach. 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). Finally, I would choose a doctor with whom you connect and whose staff is engaged and knowledgeable. Driving hurts too. I know the most important decision you will make is choosing the doctor who will perform your surgery. In severe cases, I will use my patient’s own femoral head, which is removed as a bone graft to help stabilize the new cup and “garden” new bone for the future. I’m not sure why you developed a problem with your IT band. Back to work/driving in 10 days. Total hip replacement is only considered when you have tried and failed more conservative treatments, yet you continue to have significant pain, stiffness, or problems with the function of your hip. Everything does point to posterior being the better of the two, but first i was’nt given a choice, and much easier said to shop for surgeon, than to do it, when only one in this area takes my insurance. It will help desensitize and help get your muscles working in synchrony. Need to choose, then select doctor based on that decision. Above the ankle to the thigh.Had to use leg brace to It does sound as if proceeding with a THR is appropriate, since your attempt to repair the joint arthroscopically did not pan out. In the dark to find out about this myself. Can you please on the various points in the post and perhaps also elaborate on the last point. Anterior hip replacement surgery was a novelty only a few years ago, ... we have devoted this article to a debate about the pros and cons of anterior hip replacement. I suggest you discuss your concerns with your surgeon. Anterior approach hip replacement offers an alternative to traditional hip replacement. The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior... https://holycrossleonecenter.com/storage/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 - 2020 Holy Cross Hospital. Our second opinion doctor performs traditional and Birmingham hip replacement. I have two questions – one, how realistic would it be to try to have both hips done at the same time? 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. Thanks again! Although, personally I would feel strongly about reconstructing the hip through the mini posterior approach (there tends to be considerably less bleeding with this approach), other very caring and competent surgeons might feel just as strongly about using a different approach. Going in for THR in July. Spring 2014 had trouble playing tennis, hip kept feeling like it was popping out of joint, groin pain, aching. Sign up to receive email updates and to hear what's going on with Advanced Physical Therapy and Fitness! Most patients after a bilateral procedure would not go home but rather a rehab unit. July 2013 my left hip was scoped for a labral repair. I am so sorry to learn that you are struggling. I am 37 and have suffered from AVN since I was 14. 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. for Orthopedic Care Both problems are on the right side of my body. The only problem I’ve had post hip replacement is some on/off again groin pain. Had a total hip replacement aug 2013. My surgeon uses the posterior approach. I assume it’s something near my groin. Stay was 2.5 days. Sometimes the pain goes away as I walk and sometimes it doesn’t. My advice is to have a frank discussion with your surgeon and share these concerns. After reading your article I see there are many reasons to go with the posterior approach but nothing about having to use a smaller prosthesis with the anterior approach. This is not true for bilateral cases. In short, both approaches result in a hip replacement. Lastly, if one has had P or AL is there anything that can be done to offset the need for restricitons? Posterior Hip Replacement. I am a 70 yr old female with a 4grade thickness loss at acetabulum and head of femur. There is an option of cementing the replacement parts to the bone or doing what is called a press fit which allows bone to grow into the prosthetic to hold it securely in place. Getting those studies will not change the reality that you will need THRs. 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. It sounds like he did fabulous job. As noted above, because the femur is difficult to visualize, component positioning, sizing, and stability are more likely to be compromised. Really Great. Posterior hip replacement surgery uses a curved incision on the side and back of the hip. Your article is the first I’ve read in which no muscle or tendons are cut in any approach other than the direct anterior approach. Also, the surgeon said that I would end up having one leg shorter than the other… is this true? I’m hearing ‘no restrictions’ (once recovery is done) for Anterior, but always some for the other two. This site uses cookies. For those who've been diagnosed with severe osteoarthritis in both joints, the double knee replacement or double hip replacement versus a single replacement is a serious debate. 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. I am 5 weeks out and have been doing beautifully! Your primary goal should be to find a surgeon in whom you trust and who will take the workman’s compensation insurance. Hi, I have had problems with my hip for the last several yrs. We thank you for your readership. I am a 49-year-old female. The same is true for the attachment of the prosthetic. Very strange Determining which technique to use will depend on several factors including bone quality and strength. How long will my hip replacement last in your opinion? Also on MRI there was a cyst (good size). I am a competitive tennis player in my age division. We are now in a situation where we have found two extremely good surgeons and we gel with both extremely well. Do you agree? I would recommend having an honest discussion with the surgeons you are considering. 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. I love that you take time off to reply to these messages – it is commendable. Changes will take effect once you reload the page. I worry that replacing it with a differently configured socket could make things worse rather than helping. No specifics were given to me from the orthopedist . Typically, the new cup will be medialized to gain coverage and correct the abnormality that lead to your arthritis. Very slow recovery. Does it really not matter which approach I have, posterior or anterior? Back then my surgeon advised me to perform a posterior surgery as opposed to anterior saying that I was overweight, short and a very muscular person and it would be easier and safer to do so. My clinical impression is that more patients experience some degree of residual groin discomfort or tightness after the anterior approach as compared to the posterior approach, but that it tends to resolve with time. For example, the stability of the components could have been achieved initially, but then proved inadequate so you developed either a loose cup and/or a loose stem. See Total Hip Replacement for Hip Arthritis. I am scheduled to have total hip replacement surgery in 2 weeks. If the tissues are traumatized and / or the final components are not optimally positioned, then it certainly is not an advantage. Hip dysplasia is a very common underlying cause of hip osteoarthritis. I ski, hike (steep terrain) with a pack -about 25 pds, kayak, horse back ride, swim, water ski and bike, which is getting increasingly more difficult. Anterior approach hip replacement offers an alternative to traditional hip replacement. She never though mentioned an increased risk of damaging femoral cutaneous nerve or possible muscle damage that would turn into improperly heeled muscle as a result. The doctor has scheduled me for total hip replacement in two weeks and he uses the Posterior approach, he didn’t say anything about the mini part. 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. Thru X-rays I’ve been told both hips are bone on bone! The owners of this website accept no responsibility for the misuse of information contained within this website. Does the “mini” posterior hip replacement conserve more femur and allow for future surgeries if needed ? The most important variable is how quickly the person is motivated to return to work. 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! I spoke to the surgeon, he believes it may take up to 6 months to get better from this “neuropraxia”. Thanks. Each surgeon approaches these issues individually. THR if a MRI or Pet Scan isn’t done? Thank-you. A THR is in my future. The mini-posterior approach involves separating the muscle fibers of the large buttock muscle located at the side and the back of the hip. Posterior hip replacements: Pros Provide the best view of the hip; Less likely to cause nerve damage; Cons Must maintain strict hip precautions to prevent dislocation; Greater risk of dislocation (due to stabilization muscles being cut and then reattached) Cutting of major muscles which require reattachment; Anterior … By far the most important variable is the doctor who is doing your surgery and managing your post-op care. This in turn, can prolong recovery time … I absolutely would not insist on minimally invasive surgery and a small incision, especially considering your mom is “short, obese and has osteoporosis.” What is most important is that the surgery is expertly done, that the tissues are not brutalized, and that the surgeon can see what he or she is doing. I live in the UK so again I’m afraid I won’t be able to consult you personally! I think it’s always beneficial to speak to other patients who have been cared for by that physician and learn about their experiences and results. Last summer I wiped out on my bike and snapped off the top of my right femur, with a diagonal break. Despite the recent trends, rehab is very important in order to regain your full potential and recovery. I had an anterior approach hip replacement. Hospitsl staff If a revision were necessary, even more bone must be destroyed to remove it. http://orthoinfo.aaos.org/topic.cfm?topic=a00377, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1022709/, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257425/, http://www.dartmouth-hitchcock.org/ortho/total_hip_replacement.html, http://www.arthritis-health.com/surgery/hip-surgery/anterior-vs-posterior-hip-replacement-surgeries, http://www.aahks.org/care-for-hips-and-knees/do-i-need-a-joint-replacement/total-hip-replacement/. I’m sorry to learn that you are so disappointed with your hip replacement. The hope is that these new designs will, but time will tell. He strongly recommends the anterior approach as the only way to go. Others will be empowered when they read and relate to you and/or your experience. Today, everything from tools to techniques has improved. I just want to thank you for the information on this site. Unfortunately, short of conservative and supportive measures, only time will tell. In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. The rest is marketing. Being out of bed and moving soon after surgery adds to a patient’s safety and speeds the recovery. 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 . I’ve done PT and plan to continue working on strengthening my core and flexibility of those large muscles. What is most important is that you find a surgeon who understands the particular complexities with your problem and whom you trust. Dear Doctor Leone, We thank you for your readership. I saw a surgeon who does the posterior approach only and will see another on 4/14/15 who does both approaches. Can you explain this approach? More soft tissue trauma can result do to this increased difficulty in exposure and then gaining more exposure if necessary. The anterior approach offers the fastest recovery time, but fewer surgeons perform it. Thanks so much for this information! If you refuse cookies we will remove all set cookies in our domain. There is significantly less bleeding with the mini-posterior approach, notably reducing the necessity of a blood transfusion after the surgery. After reading your article I am concerned about the issues you discussed. The posterior hip replacement approach requires surgeons to cut muscles and other soft tissue at the back of the hip, including: The tensor fascia lata, which is a wide piece of … Should I go for this – or should I opt for the mini posterior. My physical life is diminished. Sitting seems to irritate it the most. Some people also tend to form scar tissue and contracture more readily than others. My advice is to focus on finding a surgeon with whom you are comfortable and have the best chance of doing well. Also, some body structures or anatomy makes approaching a hip anteriorly much more difficult than others. Also, be aware that as the nerve recovers, the smallest C fibers within the nerve recover first, which can cause a burning discomfort. These are some of the most grateful patients in my practice. A neurologic evaluation is appropriate to rule out reversible causes, but most work-ups do not elicit the exact etiology and usually symptoms only can be managed at best. For risks she mentioned all the usual I knew about from the first surgery – blood clots/loss, dislocation, etc. Doc says once recovered I should avoid flexion with adduction and internal rotation. The posterior approach, then, is less inherently stable but may or may not require precautions. Dear Mary, I’ve since met 3 others who ended up with the mess that I’m dealing with also. Being cared for in a hospital that specializes in joint replacement and has an extensive specialty medical staff also is key. I then would trust your doctor to select the prosthetic that would deliver the best result according to your goals and allow you to return to activities that you enjoy. A couple of things I am hoping you will explain using laymans termology. I do participate in competitions and showcase presentations. I don’t 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. Many times, the depth of the destruction that is found during surgery is much more advanced than initially anticipated, particularly as we age. It is important that you find a doctor who is experienced in caring for people with complex issues. Are these expectations realistic? Long recovery but all is well. I wish you a full and uneventful recovery. Thank you for this great informative discussion. Pros And Cons of Anterior Hip Replacement Surgery. Thank you for sharing with others the “nerve supplements” that you’re finding affective. Talked to my foot doc and we decided on the Topaz procedure which has good results. 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. Thanks. The questions you’re asking are 100 percent appropriate. It is important that the individual who ultimately implants your next THR uses the approach which he or she feels comfortable with and has the best chance to deliver the optimal result. I am very athletic and active even with many years of pain from bone on bone arthritis so I am worried about restrictions since I’ll probably forget or something. Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis.Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. I don’t think one surgical approach is better or worse than the other for you to accomplish this. I often suggest to my patients that they speak to other patients for whom I’ve cared and to whom they can relate to learn about their experiences. 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? It is important that these medical and cardiac conditions be optimized by your PCP and cardiologist preoperatively. The most important decision you must make is choosing your surgeon. However, patients & surgeons in the meantime must utilize available knowledge so as to make informed choices. But this blog was a nice nudge toward the posterior. The incision used is approximately 10 to 12 inches long. Comments about life-long hip restrictions between Posterior, Anteriorlateral and Anterior approaches? Posterior hip replacements: Do your research in order to help determine which method and surgeon are the best for you. Because the surgery does not require cutting major muscles, patients typically experience less pain after surgery and require less pain medication. I’m sorry to hear that you struggled after your first, anterior-approach THR. Can you explain it to me as he didn’t go into detail. Mine certainly have. This may account for some of why the procedure is not used as often as the posterior approach. Not sure exactly what that means. Occasionally this even requires making a second, separate incision. 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. 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. Most importantly, I would meet with your surgeon and discuss all of these concerns. This too will lower your anxiety and improve your experience. However, the difference between the approach is where the incision is made to access the hip. I just saw a patient with a femoral “neuropraxia” after a anterior approach THR. I had the mini-posterior at MGH hospital. You can read about our cookies and privacy settings in detail on our Privacy Policy Page. The mini posterior approach works wonderfully and predictably when expertly performed. At the end of the day, I promise, it is not the approach but rather the person who is doing the surgery. I have a good surgeon (same one as last time) but I don’t 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? There is more than one way to perform a THA, but the overarching mechanics are the same. I wish you a full and satisfactory recovery. It is nice to see honest Q&A versus a marketing page. No feeling in my leg and no movement Also, after an accident, I had 12 screw and an L shaped plate in my heel. I went with a total hip replacement. I wish you the best of luck with your care. No, I would not tolerate the pain and immobility, if there is a reasonable way to relieve it. I wish you a full recovery. Anterior hip replacement surgery has lower rates of hip dislocation, but full posterior surgery has higher dislocation rates. Since a significant amount labrum has been removed, I think another attempt at arthroscopy would prove very disappointing and I would not recommend it. So what are the pros and cons for having a posterior or anterior hip replacement? Even though I was positive I wanted this method done, I was still questioning my decision. 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. Fortunately you live in a part of the world where there are many capable orthopedic surgeons. The art of surgery should mimic a well rehearsed ballet or symphony. Its' widespread use has not occurred since it literally is 180 degrees from the posterior approach in terms of how the surgeon views the hip anatomy. Click to enable/disable Google reCaptcha. I’m now 6 weeks out and doing good. Muscles and soft tissue that typically keep the hip stable are then cut, including the fascia lata, gluteus maximus, and several external rotator muscles of the hip.

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