I spoke to the surgeon, he believes it may take up to 6 months to get better from this neuropraxia. Also, the choice of femoral stem is more likely to be influenced by the approach and not the persons anatomy and hip mechanics. Brian Tinsley. With the ease of movements during pregnancy, you will be able to move around more freely. When a patient feels better, they can return to work almost immediately, though it usually takes two weeks or longer. Driving hurts too. I also would find out your surgeons recommendation regarding activities and restrictions. 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. Each surgeon approaches these issues individually. Some patients have no pain at all, which is remarkable. 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 had an anterior right hip replacement in late 2010, I was 72. 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. July 2013 my left hip was scoped for a labral repair. Simply, we keep trying to get better. For many years, I performed bilateral THR and bilateral TKR procedures, but have backed away for a variety of reasons. I had no inkling of this till he showed me on the x-ray. The femoral prosthesis is inserted into the hollow part of the femoral shaft. Can I make an appointment with you. Ive 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. 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. Today, everything from tools to techniques has improved. What is SuperPath Hip Replacement? emergent norm theory quizlet. http://holycrossleonecenter.com/blog/hip-resurfacing-or-total-hip-replacement-a-candid-discussion/, http://holycrossleonecenter.com/blog/metal-on-metal-hip-replacements/, I wish you the very best recovery. Dr. William Leone, Hello Dr. I am so sorry to learn that you have had such a bad experience after THR. I read hip dislocation is 28% higher after a revision, is it more then 28% after 2 revisions??? surgeons certainly do not go out of their way to cut anything, they move stuff about, if tendons do get damaged, it's more likely from the anterior approach as they have less 'sight' of the procedure due to the smaller incision. I would focus on the individual doctor, not the approach that the individual choses to use, to deliver the best result. I wish you only the best, Many, many interactions and decisions go into the final result as well as someones perception of his or her result and experience. While new techniques, instruments and prostheses have been developed specifically for minimally invasive surgeries, there are many well-established approaches to hip replacement. Between your legs, you should sleep with a pillow for the next six weeks. Posterior, mini posterior or anterior? I am now bracing myself for THR surgery within the next year and am wondering if there is any big advantage in trying to have this done by a surgeon who offers the customised implant, as above. Cant afford a dislocation or other complications cause Im sole caregiver for severely handicapped son. I have been doing ALOT of research about the different approaches to THR and looking for the absolute best surgeon. Blood clots or bleeding. Avascular Necrosis AVN of the femoral head happens when part of the ball at the top of your thigh bone loses blood supply, causing that segment of bone to die. Blog The first is that it is a major surgery, so there is a risk of complications such as infection. There are many factors that contribute to whether or not someone is a good candidate for anterior hip replacement surgery. I wish you the best of luck. This means you could go home within 23 hours after surgery. I'm scheduled for THR on the 22nd. Although anterior approaches can be useful for some, they are not for everyone. These cookies are strictly necessary to provide you with services available through our website and to use some of its features. 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. Hi, As for doctors, the surgeon I had came highly recommended. Original Medicare (Part A and Part B) will typically cover hip replacement surgery if it's medically necessary. You are to be commended for taking the time to answer our questions. A hip replacement involves removing the ball (femoral head) and replacing it with a metal or ceramic prosthetic ball. Hip replacements might keep you out of action for a considerable period. What you can do is keep as good an attitude as possible and keep rehabilitating your leg. Or are x-rays definitive for determining the exact reason for THR? Hip replacement via SuperPATH approach had a longer operation time than hip replacement via conventional approaches. Im sorry to hear that you struggled after your first, anterior-approach THR. Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. I would suggest seeking out doctors who specialize in hip replacement surgery rather than general orthopedics. Your back does need to be evaluated as well. Length of hospital stay with SuperPath hip replacement approach. One advantage the ceramic-on-polyethylene carries is the lack of . Do I have a high percentage of hip dislocation after a 2nd revision done posterior way if so what is my chance of another hip dislocation even if I do the surgery again? Also, if this nerve injury occurred, I would expect these symptoms to be present immediately surgery, not five months post-op. Hip replacement currently consists of two major approaches: direct anterior and anterior approaches. On the other hand, there may be a slightly increased incidence of anterior instability. A recent article published by the Journal of Bone and Joint Surgery has demonstrated that the direct anterior hip replacement has more blood loss, a higher risk of intraoperative fractures, an overall higher complication rate and no difference in outcomes versus other techniques. Dear Dr. Leone: Dr. Robert Sigmund is a board-certified orthopedic surgeon and a sports medicine physician based in St. Louis, Missouri. I wish you only the best. Please comment. With that said, I would have probably just done the posterior with you if we lived in the US based exclusively on the time you take to respond! Also available today are larger modular heads, made possible because our plastics are so much better than years prior. It sounds as if you had a wonderful surgeon. 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. Also, patients with shorter femur necks and genu varus (lower angle between the shaft of the femur and the femoral neck) are more difficult anteriorly. Consuming excessive-fibre and wholegrain meals will assist to keep you feeling full, and will be My main concern is that I have a tilted sacrum and a very sway back. Either and all body types lend themselves to the posterior approach because it is more extensile (can make it bigger and release more soft tissue structure if needed). It is a mix of anterior & posterior. It will help desensitize and help get your muscles working in synchrony. They thought surgery to repair it would give me about 5 yrs. Can I expect any problems with the bilateral it was my choice. After reading your blog Im thankful he suggested this approach. Do you have any advice or ballroom dancer THR stories to share? He strongly recommends the anterior approach as the only way to go. Surgeons do not cut across muscles. 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 . Risks of SUPERPATH hip replacement surgery Risks due to the surgery may include (but are not limited to): Pain Bleeding Infection Permanent or temporary nerve damage Extra bone or tissue damage Drop in blood pressure during the procedure Leg deformity Blood clot or clots (that could travel to heart or lungs) Delayed wound healing Celle said: Superpath may give you a faster early recovery, but whatever method is used, recovery is still going to take a long time. 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. When discussing the options, my surgeon all of a sudden suggested performing anterior approach. I wish you a full and satisfactory recovery. I am a 49-year-old female. Many believe that this results in less risk of infection. 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. If they are really happy, then you probably will be as well. A major hip replacement can take up to four months to fully recover from. Can you please on the various points in the post and perhaps also elaborate on the last point. Is THR something that can help? Because of this, when you're ready to get up and walk about again, engaging your muscles and hip flexors might be extremely tough. Thank you, Rita. Again, considering my own practice, I routinely see my patients recover faster and easier after their second hip or knee replacement because they are more confident having had a good first experience. Also many folks develop peripheral neuropathy in their lower legs, which also becomes more common with age. I then would strongly suggest you trust that person to decide what approach and what prosthesis predictably will deliver the best results. 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. Most traditional hip replacement models are metal-on-plastic varieties. Can you compare/contrast to the other approaches; posterior, mini posterior, anterior? There does appear to be an increased incidence of stem instability when implanted through the anterior approach, but I believe this is largely a function of the surgeon experience. Most activities of daily living have an element of hip flexion (knee up to head), which is a safe position after the anterior total hip. But this will always prompt you to accept/refuse cookies when revisiting our site. 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. 5. My first bike ride was 22 miles without any problems. Need to choose, then select doctor based on that decision. It can lead to numbness in the thigh and, in rare cases, skin irritation due to the nerves presence. My knee and foot and ankle are messed up too since leg ended up at least 3/4 shorter.I wear a shoe lift, but probably needed it sooner than I realized the shorter issue, My knee is pretty stiff and pain when I walk too much, but I deal with it, it bends good, I sleep good, no pain when I do nothing, so Im working all to do NO knee surgery, This hip was ENOUGH to last a lifetime.. Im 76 and use a lot of supplements to save knee and OA in general..I am looking at other protocols for the knee too.not insurance covered, what else is new.if its good, its out of pocket. My doctor does the Posterior approach, he didnt say anything about the mini part. I wrote to you in January, now my surgery is in a couple of weeks. I had to cut some strength exercises out leg lifts, hip sled. Choose your surgeon and not the approach or prosthesis. #1. Recently the doctor doing anterior decided because of thin bone, he should do direct lateral approach. 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. If possible, choose a hospital that specializes in joint replacement and can back that up with excellent statistics and reputation. Its been a couple months and I thought Id drop in with an update..over 4 yrs post op and I deal with Femoral nerve damage from Anterior, and found others who deal with the same.it may lessen with more years but who knows.Somewhere I read 15% or so end up with this..I talked 2 other people in my city, same surgeon and they have had this issue to. We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website. 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). I came home with crutches, abandoned them at the front door and have not used them since. 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. A lot of hospitals and ambulatory surgical centers offer what's called outpatient surgery. If an MRI demonstrates no cartilage damage or subchondral cystification (the development of degenerative cysts), a repairable labral tear and minimal dysplasia, then a hip arthroscopy may be considered. You should keep in mind that the vast majority of hip replacement pain reduction surgery patients are satisfied with their final results. My strategy is to make as small an incision as possible, but one that allows for excellent exposure and reconstruction without brutalizing the tissues. Hip replacement surgery is typically performed in a hospital and requires at least one night in the operating room. 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! Pain and disability are reduced. You should feel good that you are aware of your fears and that it hasnt paralyzed you into not acting. Dear Doctor Leone, He is one of the few surgeons in the U.S. that performs total hip replacement via a superior capsular approach, the most soft tissue-sparing hip replacement available and is an industry educator in the . My second question relates to something you mentioned earlier regarding checking the published track record of the surgical team if I use an HMO, how do I find that information, and how do I know it hasnt been skewed to give more favorable results (lying with statistics)? Thanks so much for your help, very grateful. 3. 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. Sitting seems to irritate it the most. Still going to rehab to reduce stiffness and increase strength but I am in better shape now than before surgery. 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. Its been my experience that femoral nerves tend to recover more readily than sciatic nerves. Thank you. Nobody wanted to talk I just had mine 10/30 all I can say is be patient get lots of rest and take your pain meds way before you start to move around so that the pain want be so bad with movement. Patients can also have as little as a 3-inch incision. And does A really have none. The anterior approach has a lower incidence of sciatic nerve injury and a higher incidence of femoral nerve injury. Uncemented. I would avoid the metal-on-metal articulation. I deal with major nerve damage on front of thigh, almost whole thigh.
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