I am a 73 year old woman who has been having severe hip pain for the last seven months. I understand that most surgeons now do a spinal rather than general anesthesia. She provided all kinds of “benefits” with this approach, as faster recovery, less motion restrictions et.al. The incision curves just behind the greater trochanter, the knobby bit of bone that sticks out at the side from the top of the femur (thigh bone). Anterior hip replacement recovery is faster and offers other advantages. THOUGHTS? What are your thoughts on the use of robotics? Most THR patients do not need significant supervised physical therapy after surgery; they simply do well when their surgery is done well. 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. The doctor is planning a traditional posterior. I am Australian so no business from me but it has helped me become happier with my prospective surgeon’s judgement that he will offer me a posterior THR (hopefully the minimally invasive) when my insurance allows the procedure to occur. That being said, if the foot is now a much bigger problem than the hip, you may have to deal with that first. I find it curious that you report having a good result for the first five months after your surgery as this suggests that the surgery was done for the right indication, i.e., you did well and were pleased for the first five months after THR. The majority of teaching institutions in the United States continue to instruct as well as perform the traditional posterior as their primary approach. The highly crossed linked polyethylene liners are now the gold standard in this country. 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. I now need the right hip replaced. Dear Dr. Leone, More soft tissue trauma can result do to this increased difficulty in exposure and then gaining more exposure if necessary. This is not true for bilateral cases. I was thinking of a Hip Resurfacing for my left hip and was convinced by my other top hip surgeons to stay away from it. That means you have an excellent track record. Mine certainly have. I also think infection must be investigated and ruled out. 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. 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? Regarding restrictions after your hip replacement, this too is an area that has changed drastically over my 25 year career. I think it perfectly “ok” to discuss different approaches and ask for an opinion. I do not have dials and no one seems to know where the neuropathy stems from. July played my last match when I buckled. 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. Further, the extent of dissection is more minimally invasive, which also improves stability. Are expected to be out of bed (hips and knees patients) the afternoon of their surgery and at least taking a few steps if not walking. The anterior approach is a different method of hip replacement which is not used as frequently as the posterior approach. Total hip replacements or arthroplasties (THA) are one of the most commonly performed joint replacement surgeries. It’s been six months since surgery, my operating doctor keeps feeding me with “let’s wait another month” stuff. 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 hasn’t been skewed to give more favorable results (“lying with statistics”)? My husband, who is only 35, has to consider a THA in the near future and I’m very torn over which approach as the surgeon we really like dos a posterior but I am concerned about dislocation rates in posterior vs anterior. 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. So frustrating. Thank you for this great informative discussion. 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. Regardless, the overall incidence of dislocation for every approach is smaller due to use of larger femoral heads and enhanced closure techniques. (tho’ I am sure I asked about it ahead of time), I believe you are having trouble finding definitive answers and recommendations because every surgeon has his or her own recipe and experience and also the medical recommendations keep changing. Your back does need to be evaluated as well. I never seem to know when I am going to get hit with pain. Recovering patients can bend and stoop, reach their feet, cross their legs and sleep in any position they want to sleep. Also, how about hip restructuring instead of Total Hip Replacement. This complete wall of tissue that surrounds the new hip imparts stability. Thank you, Lisa. I am a South African and need to make a decision on whether my mother (69) goes for an AMIS or traditional posterior. Less post-operative pain. Problem is that we have seen two doctors and both seem great but are on two extreme sides of the fence. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. 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/. What are your thoughts with regard to Stem cell therapy in lieu of THR? I’ll know a lot more after we meet and I review your X-rays. 2. I would encourage you to discuss your concerns with you surgeon. Kenneth, You saw me in your office yesterday (I am 48 years old) as I had complications following a THR of right hip anterior approach with revision 4 days later for a slipped acetabular and then last week I had a dislocated hip. Tossed the cane at three weeks and went back to work. While it is a surgery that does help many, many people, clearly you are struggling. I dont want a long recovery time as I am very active. Once again, it sounds as if you had a wonderful surgeon, which is the most important variable. This effectively moves the hip joint center, toward the bladder or midline, and improves hip mechanics. In hopes that THA would let me live my normal life without arthritis, instead I can barely walk more than 100 yards without having to stop, my gait is crooked causing lower back problems and my personal life is less than perfect. 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. I think it perfectly “ok” to discuss different approaches and ask for an opinion. 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