Approaches To The Hip: What’s The Difference?
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- Опубликовано: 23 июл 2018
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In this episode the surgeons discuss different surgical approaches to the hip. There has been a lot of interest in the anterior hip approach recently. This video compares anterior approach to lateral and posterior approaches.
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I had a hip replacement almost a year ago. What a difference it made in my life. I am a 85 year old active woman and I am back doing everything I did before the hip started to get very painful.
The surgery went very well and I was able to go home the next day. I followed the instructions very closely and was able to get around within two weeks.
I would say the hip is just perfect, in fact it is better than 100%
Doctor Weening was wonderful with me and never treated me like an old person.
I would recommend this surgery to anyone in advance years to have the surgery and enjoy a better quality of life.
Hi Joan! Thank you so much for sharing your story and so glad we were able to help you get your life back. All the best to you. Thanks for watching and subscribing
You two doctors are so natured, and are smiling a lot and relaxed, which makes watching your videos enjoyable, and I am sure it also makes it enjoyable for your patients interacting with you.
We are doing our best Donald thank you. Thanks for watching and subscribing
Been 4 weeks since posterior hip replacement. (Elected by my surgeon)... Important to note I'd been in automobile accident and had my pelvis shattered a year prior. My pelvis healed with aide of hardware but I had no cartlidge. I was bone on bone and needed a total hip replacement. Now, 4 weeks after surgery am walking with mild aide of a cane. Absolutely incredible procedure and am blown away by how rapid my recovery is going! Tip... be smart and do exactly as instructed by abiding to limitations and exercise as guided. You'll begin to get your life back and it's an A-mazing thing! God Bless❤👍
Hi Arthur. So glad to hear that you are doing so well and so quickly! The best is yet to come as they say. Glad we could help in any way possible and thanks for sharing your personal experience. And thanks for watching. Take care
I don't think my hip will be OK. I have a 9 inch scar. It hurts to put weight on it and I'm a small person. I've had 2 total knee replacements that were very easy. And before that I had 11 back operations. My back was the worst surgery of all of them!!!
Had the anterior approach on my right hip, from day one NO PAIN at all after surgery as well as no restrictions ! I did not take any pain killers. The hip joint was a little tight after surgery that was it. 10 days after surgery I was walking with no pain and no limp totally amazing. Driving within two weeks. I had P/T three times a week for a month. If given a choice I would highly recommend the Anterior Approach if your surgeon does not choose to utilize this method I would strongly suggest finding a surgeon who does.
Thanks for sharing your experience Ken. Glad you did so well. Thanks for watching, subscribing and sharing if you did.
I'm scheduled to have my hip replacement surgery in January. My doctor is doing the anterior method. I'm barely able to walk at this point and am in considerable pain. The people I've talked to who have had the anterior surgery done are very happy with it. I'm glad you've done well! I'm looking forward to getting my life back!
I had a posterior approach total hip replacement December 12, 2022. my recovery has gone so well that I’m doing my right side February 6. Eight weeks after my left. I have had no rehabilitation outside of exercises my doctor gave me. I completely disagree with finding another doctor simply because of the approach they pursue. It’s better to ask why he wants to approach it the way he is recommending. Couple his response with his experience and you may find yourself having a great experience in recovery. That is my case and I cannot wait for my surgery February 6. I look forward to the relief and recovery like I’ve had on my left side, even though it was a posterior approach.
@@romanlopez5295 I am having the same thing April 24 I am seeing bad stories about the anterior way is to go. It scared me off once but I can not live in this pain daily. Glad I see at least your doing good. I having Mako robotic done . I hope I do as well as you .
My scar for anterior was 8 inch. Average scar for posterior 14 inches. No rehab for anterior other than walking. Playing golf at 3 month recovery with anterior.
I would recommend Anterior.
Excellent video! Put out at a great time as I continue to find the best surgeon for my THR. Thanks for explaining all 3 approaches and making it clear what's entailed. 💯❤️😉
Hi jdpowerzz22. Glad to hear it helped. The approach to the hip is a very hot topic right now and we just wanted to try and help people understand the choices and the differences between them. Ultimately you can get a good total hip from all of the approaches mentioned. Good luck
5/5/20 anterior approach for me ! no pain since waking up in recovery[,tylanol only]i mean no pain.walked 3 hrs after surgery ,went home next day walked without any walker/crutch/cane over a mile,walked 3-4 miles a day for7 days,back to work on day 8,[mechanic,no desk job]started bike riding after follow up appointment,can ride over 10 miles at a time,hard! I am so happy, my energy level is so much higher after work & thats not even 4 weeks after surgery! I personally cant see why anyone would do it any other way!
Congrats scott! Sounds like you have done very well. Thanks for sharing your story. Thanks for watching and subscribing if you did.
Happy
My experience very different. I fell while on vacation and the head of my femur completely broke off. Second day in the hospital I was operated on posterior approach. Minimal pain but complications include atelectasis both lungs which kept me in ICU for 10 days. 16 days in hospital. I am a retired NP who worked many years in the OR. I never met the surgeon just residents. I’m 65 yrs old with osteoporosis. I did 5 days in patient rehab. No other rehab.
@@NYCgirl927 So sorry what you experienced. If you don't mind me asking, how did your surgery and recovery go?
@@eaglerider94 Sx & recovery went well. I did inpatient rehab for a week and flew home. No problems until 1 year later when I pivoted fell and Fx my L/arm. The head of my humerus broke. Pins, plates and wires.
Thanks for an excellent video. I'm having a THR in a couple of months. My surgeon is an anterior approach guy, and I now feel really fine about this, due to the information you gave here. "The approach itself is probably not critical" and "You want your surgeon doing the approach they're most comfortable with." Good advice! Thank you!
Hi Trish. So glad we could help in any way. The take home message is exactly as you said - you want your surgeon to do the approach that he/she is good at. The main difference between the approaches is some subtle differences in complications all of which are very rare and potentially some early benefit from the anterior approach with respect to mobilization however this equalizes around 6 weeks. We want our patients to have good hips for decades not the first 6 weeks. Thanks for taking the time to comment and for watching our channel. Good luck with surgery and keep us posted.
@@TalkingWithDocs Thanks for taking the time to reply - wasn't expecting that. I just need to say I got my surgeon's approach wrong. He's a posterior guy, not anterior. Your advice still stands. Yayyy!
@@trishhockly8934 If you don't mind me asking, how did your surgery go?
Great video, very understandable of all of the approaches. I had a broken hip replacement in 2016 and have had no issues except some arthritis pain. Would love to hear that type covered. Thank you, you are one of my favorite channels!
(I had the lateral approach done)
Thanks so much Paul. Glad you subscribed and that you are ok!
My wife just returned from her specialist. She's been getting injections for the pain over the last year but they start to fade about a month later. He was ready to administer another injection when my wife suggestion talking about surgery and that she can't handle the 24/7 pain and sleepless nights any longer. He agreed and referred her to a hip surgeon 10/6 for a THRL. I immediate turned to RUclips and found your channel in order to learn as much as I can. Guess the next step is to see which procedure is best. I'll subscribe and forward to my wife as well.
I'm having a total hip replacement in a few days. Your videos have been absolutely wonderful. I tend to research everything and I have found a lot of comfort if it will and your explanations. Thank you so much.
You are very welcome Terri. Best of luck this week. Thanks for watching and subscribing if you did
You 2 Doctors are so entertaining and informative. I have an up coming hip replacement and because of you two I feel alot better about having it done. Might even be 2 replacements but I won't know for a couple more weeks. Cheers!
Thanks so much Bill. We do our best to keep people informed and try to keep it a little lighter especially these days with all of the things going on in the world. Best of luck with your surgery. Keep us posted and thanks for watching.
I recommend these guys on THR Facebook groups!
very informative and good clarification about the three types of entrance to the surgery spot.i am 6 days out from anterior right hip replacement at home on day 3.surgeon and nurses and pyhsio been great.you guys rock thankyou
You are very welcome norman. Best of luck to you. Thanks for watching and subscribing if you did.
Thank you for the great video!
Hi Dewey. You are very welcome. Thanks for watching.
Thans very much for detailing the approach of hip replacement
Hi Sharif. You are very welcome and we hope it was helpful. Thanks for watching.
Great video Docs, good explanation.
Very welcome Darlene.
I had an "unscheduled" THR due to a fall & fracture, so I didn't have the luxury of prior measurements, discussions or planning and prepping. All said I feel very fortunate. This RUclips answered my questions about why he chose the approach he did (since he specializes in another) so now I have more time for other questions when I see him. Thanks, following!
Best of luck
I am soooo glad I found your channel. Just had THR on 08/09/21 (posterior approach). Recovery has been steady improvement.
Well good luck Angela! Best of luck during your recovery. Thanks for watching, subscribing and sharing with someone if you did.
Thanks docs for the very good information!
Very welcome Alida. Thanks for watching and subscribing
Hi Docs, new sub, loving your videos. I am 2 wks post op, posterior THR. Going back tomorrow for staple removal. I am very happy with my progress, getting in as many step as before my surgery. (bone on bone before surgery) I look forward to the next few months, I feel great.
Congrats! It will hopefully just keep getting better and better. All the best. Thanks for watching and subscribing
I am an older high end skier that is having serious issues with my left hip. My surgeon has kept me on the slopes for over 22 years since I was told I was done when I was having knee issues. He is a posterior guy and after viewing this video I am more confident that he is taking the right approach as I was getting mixed opinions. I hope to be back on the slopes 6 months after the surgery and will not be doing mogul fields for hours on end but at least I'll be back.
Sounds like a solid plan Bob . All the best to you. Thanks for watching and subscribing
Hi Doctors, what would you recommend for a female 34 years who needs a hip replacement, ceramic on ceramic or ceramic on highly cross linked polyethylene?
Thank you in advance for your advice
I’m going for a hip replacement soon my doctor does it from the front , he’s been doing this for years and I have confidence in him & like you said and he said I might go home the day of surgery if I can stand up ! Thanks Doctors !
Very nice Mark! Good luck. Thanks for watching and subscribing
I had the "Superpath" approach done on my right hip back in 2014 with excellent results to date. Within a day I was doing stairs, could put my own socks on without too much difficulty, and two weeks later I was mowing the lawn. At the first follow up, they said I was doing too much to quick, what he thought was a common issue with such a relatively quick recovery surgery.
Thanks for the information. I will be
meeting with a surgeon to discuss my THR options. This gives me some comfort🧐. I will keep you posted.
Best of luck!
@@TalkingWithDocs Thank you.
I am happy with my laterl hip replacement after 3 weeks, I am doing the exercises throughout the day and strengthening my thigh muscles. Still hard to bear weight on surgical leg when doing standing exercices on the non-surgical leg, but improving range of motion. I need to be patient because I have used a walker for 2-3 years, but think I will be walking free eventually. I also had a knee replacement about 1.5 yrs ago. I enjoy your videos, and the explanations, thank you. I enjoy the humour, too.
Thank You for the info. I'm in the US but find your info best so far. Need both replaced. Just completed PRP.
Too little too late in my case. Now looking into replacement. Thank You
You are very welcome Mary Ann. If it's any consolation, PRP has little evidence to truly help significant arthritis. Best of luck with your surgery in the future. Glad we could help in any way. Thanks for watching and subscribing if you did.
@@TalkingWithDocs sure did!!
Actually my doc pretty much told me which type he does. I told him my activity level, which is extensive, and he said posterior is all he does for everyone. I’m 11 days out and doing well. Pre surgery hip was total agony therefore recovery pain, which was to be expected, feels WAY more bearable. I’ll never forget that agony of severe arthritis in my hip affecting every single thing I did for almost 2 years.
Thanks for sharing. Glad you are doing well
These blokes are so good
Thanks so much Neil! Thanks for watching and subscribing
I just had my second anterior approach. Twenty-four hr hospital stay. Woke up in recovery room with severe chest pain. Treated with nitroglycerin and IV meds. Had more pain that night and the ortho on call ordered an antacid! Released next morning only to return two days later with heart attack! Do orthos not learn about cardiovascular medicine?
Thx you
Having a posterior hip replacement, is a fluoroscopy necessary or do they no longer do it?
Anterior hip replacement in April 2021, complete disaster! No feeling in leg from knee to hip. Physical therapy 3X week with limited success. 15 years ago posterior replacement on other hip. 12 weeks complete success, no pain, no problem! Good luck 🍀!
Sorry to hear that John. Yes all approaches have some risk. Thanks for watching and subscribing if you did
Thanks for the video. I have a few questions, I see you sometimes answer them. What approach do you think might be best with people with pudendal nerve pain ?( pudendal neuralgia ) Also what about post less ( perineal post ). Do all approaches use a post ? I see some doctors advertising post less surgeries, but none of the major hospitals and none of the most well known surgeons do. There is some talk about a padded post. Thanks for any insight into what approach you feel would be best for people with pudendal nerve pain.
Hi Ron. So with lateral approach you use bolsters front and back but usually not on pudendal nerve. Some anterior approaches need central post. Best to talk to your surgeon. Best of luck. Thanks for watching, subscribing and sharing with someone if you did.
Love the videos, thx for all the information you share.
My question: After posterior hip replacement.
On average when do you give green light to playing golf again with full swing for competition purposes? (not just chipping)
I'm a 60 year old.
We say roughly 3 months. Confirm with your surgeon though. Good luck
Appreciate it
Thank you
I am due a replacement soon
I am concerned about the hip coming out.
Mainly due to my work position is a low seated position. I am a chiropodist mainly doing domiciliary appointments.
Also I play a lot of tennis
Is the anterior approach in your opinion best suited I am 58 yoa
Hi Simon. All approaches are successful. One benefit of the anterior approach is slightly quicker return to work. Long term they are all the same. Thanks for watching and subscribing if you did
Thank you for the differentiation of the approaches. Apart the fact that it depends on the preference of the Surgeon to which approach he is "used to", please advise to which "patient's case" does each approach is applicable i.e., for fracture, hip dysplasia, deformity, etc. Because if the success rate is the same after few months, why not take the anterior approach where patient can heal faster. Thank you to kindly enlighten.
Hi my symphonias. Every patient and cause is a bit different. Some would argue that in larger patients the anterior approach is more difficult. There are different potential complications with each approach. The lateral approach provides better access to the femur if there are any abnormalities there. There are just so many variables. Best to have a long discussion with your surgeon and find one you are comfortable with. Thanks for watching, subscribing and sharing with someone if you did.
I've been hearing different things about approach & long term dislocation possibilities. Anterior lessening the already low chances. I'm very concerned about dislocation due to the fact that I surf and getting back to it will be my main priority. Although prosthetic longevity is something to think about, dislocation takes priority as far as I'm concerned. I'm relatively young at 49
Hi eero. Dislocation rates are very comparable between lateral and anterior approaches. Posterior approach may be slightly higher but this is very patient and surgeon dependent. Modularity of implants has drastically reduced rates as well. Best of luck getting back to surfing. Thanks for watching, subscribing and sharing if you did.
I've heard complaints about foot drop after total hip replacement. I wonder if this is more likely with any one technique over another. Is any one of the techniques more likely to be successful for an obese person?
My surgeon will use the superpath or direct superior approach for my hip surfacing sugery. Claim is muscle sparing. How is this method seen compared to the approaches you use?
Hi Robert. They are all quite good. Some have a slightly quicker recovery. The complications are all rare but differ between approaches. All the best. Thanks for watching and subscribing
Question - how common is it for a senior with a femoral neck fracture (repaired with screws) to need further surgery/hip replacement at some point?
Hi Maryland. It is hard to say exactly but likely 30 percent of the time. Thanks for watching and subscribing
I am 28 and in need of a THR due to osteoarthritis, my surgeon mentioned he recommended a posterolateral approach, is this the same as the lateral approach mentioned in this video or the posterior approach? He mentioned detaching smaller muscles such as the piriformis. I have been trying to find some info online but I can’t find much. Thanks and you guys rock :)
Hi Sarah. Sounds like the posterior approach. Thanks for watching and subscribing
I've heard that the big difference between the anterior and posterior approaches, is on a rehab standpoint, you have less restrictions with the anterior approach in terms of what you can or can't do afterwards, than you do with the posterior approach.
Hi Jordan. We would say the early restrictions and early recovery are the biggest differences. Slightly higher risk of certain complications like neuropraxia. Long term outcomes are the same. Thanks for watching and subscribing
I am having the posterior Mako robotic April 24. Is there a reason why my surgeon choose this approach? Any help would be appreciated. Learned so much from your videos. Thank you .
Hi Sherri. There are many successful approaches. Likely the one that he or she is best at
@@TalkingWithDocs Thank you so much. Appreciate you getting back to me.
I've watched several THR videos and they look a LOT less straight forward than the animations LOL. I've gained a whole new respect for surgeons! In each of the videos, I see the surgeons using what looks like some kind of electric scalpel. What I'm wondering about are the (I don't know how else to put this) little chunks of flesh(?) removed to gain sufficient access to see what you're doing while performing the implants. By the amount of material cut out, I'd almost expect (barring swelling) there to be a hollow indent following the operation. Besides the labrum, is it just fat that is being cut away and discarded, or what? And whatever it is, does it simply grow back? And thanks for being so responsive to questions. It's a rare thing in YT comment sections.
Hi Ross. Good question. It is more cutting through rather than removing the tissue. There can be an indentation however this is rare. Hope that clarifies things. Thanks for watching, subscribing and sharing if you did.
I have a THRL scheduled for 10 days from now. My surgeon does the posterior approach, and he has done these for 35+ years. I'm both scared, and extremely excited to get my life back. Avascular Necrosis was my diagnosis, and I found out that it runs on my fathers side as he has had both hips done, and my sister is beginning to have symptoms.
Best of luck. You’ve got this
How are you doing? I am having the same surgery but robotic Mako. I am seeing others had issues. I hope that was not your case. I am scared myself. But not being able to walk and living in pain daily has to go. Hope your doing well .
@@sherrid5315 I am recovering very well. The evil nasty bone pain was gone immediately. Now it's just muscle repairing itself, which is uncomfortable, but VERY preferable to the hell I was in.
@@tccell212 Glad your doing well. Thank you for getting back to me. I am nervous not going to lie because I am seeing to many negs about this surgery. The pain etc. Thank you again.
My hip was done anterior, I was able to bend down and tie my shoes, did not have to keep my legs apart and have no loss of sensation to my thigh BUT...I did have a problem with sciatic pain after...that was not taken care of by the pain clinic and infusions in my back bit it was taken care of by my acupuncturist and has never come back. I am 77 yrs. old and I do not feel any pain in my hip. My knee however is different, it is very temperamental and is subject to swelling when the barometer plays tricks. Since I live in FL...that is often the case. It does not care for humidity either. I had the knee done 6 yrs. ago and the hip 3 yrs after that, both on my right side. What I find hard is that I no longer have the strength that I would like on my right side and that I can not stoop down anymore. Any ideas what I should do?
Hi Micheline. Thanks for sharing your story. Bending down can be difficult. This requires a lot of strength so best advice is to work on strengthening your muscles to improve your mobility. Hope that helps. Thanks for watching and subscribing if you did.
Great video and nice to have this resource. Have watched a few of yours. Here, I think it would be worth mentioning the different precautions of the different approaches. They are different. A persons lifestyle may make a difference. I just had my 2nd Anterior THR. My doc says I can’t golf. Since I don’t golf, no worries. Posterior, I hear, low sports cars can be a problem. Anyway, my 2 cents. Thanks for the info. You guys seem to friendly and cordial to be surgeons. (JK, but surgeons have a reputation of being a bit stuffy!)😏
Hi azgirl. We do our best to be friendly and cordial and yes, surgeons do have the reputation you mention - probably deserved. So very good suggestion about activity restriction. Golf is important to a lot of patients. We currently perform the lateral approach and golf is fine for that approach. It is always a good idea to discuss with your surgeon what your goals are after the procedure and that includes recreational activities. Good luck in your recovery and thanks so much for watching.
Is numbness common around the surgery site and beyond for a period of time post surgery?
Hi Susan. Numbness is not uncommon. If it persists, it may be worthwhile discussing it with your surgeon. Thanks for watching.
What I like about the anterior approach is that there are normally no restrictions during recovery (crossing your legs, bending ,beyond 90 degrees, needing raised commode, etc. Are there restrictions with the lateral approach? I am VERY anxious that I would forget the mentioned restrictions and dislocate my hip during the recovery period and I need this done soon to my right hip.
Hi Steven. Yes there are some restrictions with the lateral approach. There are also restrictions with the anterior approach - like extension of the hip. Thankfully the risk of dislocation with either approach is very very low. Hope that helps. Thanks for watching, subscribing and sharing with someone if you did.
@@TalkingWithDocs Thank you for your reply. Like your videos!
I have hip dysplasia, and about to have posterior approach. My surgeon also does PAO (Peri-Acetabular Osteotomy) but said he found they last on average 3.5 years so was no point. He has to rebuild my shallow hip sockets is this only done with posterior approach?
No you can do a total hip through any approach. Often with dysplasia the socket is shallow as is the anterior wall. Best of luck. Thanks for watching and subscribing
what is the best approach to hip replacement for a right handed golfer having a left hip replacement?
Hi Lyndsey. It is hard to say. All approaches have good long term success. It is a personal decision and one that should be made with your surgeon. Best of luck. Thanks for watching, subscribing and sharing if you did.
How often do people need the other hip joint replaced later? How long does the an artificial joint last on average?
Hi Kat59. So it varies. It is common to have both done though. Most artificial joints would last 12-20 years however it is very variable and depends on many factors. Hope that helps. Thanks for watching and subscribing if you did.
Update: hematology doctor cleared me, right hip replacement (anterior) scheduled for July 14th. Dr. Raymond Payne will have to make a small incison first to remove the three screws he inserted in Feb to repair the stress facture in the femoral neck. Hopefully that won't be a big deal. I'll be knocked out anyway.
Hi Dan. We replied to your other post but best of luck to you! Thanks for watching.
Going on my 6 hip replacement,only had my last hip less than a year at that time not all parts were replaced and now my femur is loose so another major surgery,I am scared .
Having Mako hip in 2 wks with the other side to follow. 5 months ago had Mako total knee to which I am still having swelling issues. Feels like a tight band around my knee 24/7 increasing after exercising with floor peddler. Dr says swelling could actually be from my hip. I’m not a Dr…I am hesitant to accept that tho. While recovering from knee I used an ice/compression machine. I see alot of different hip icing methods online; how do you recommend your patients to reduce swelling after surgery? Thank you for all the videos you two Dr’s make for us. I’ve watched many of them.
Hi a law. The swelling can persist for 6-12 months in the knee. There are often sleeves for the hip that you can use for the compression devices like the one you used after your knee surgery. Best of luck. Thanks for watching and subscribing
My surgeon is particular about who he does the anterior approach on. You cannot have a dislocation or be obese. No can you be diabetic. I had the anterior approach and my recovery was so easy that I would never have any other approach for my other hip when it needs replaced. By day 2 I was driving. By day 6 I was back to walking 10,000 steps per day. I had a total of 3 days of PT. I was able to do the exercises at home myself after that. At the time of surgery I was 65 and very physically fit.
I have SI Joint Dysfunction. If my SI Joint is "out of place" prior to my right hip replacement, will that affect the outcome? I've watched videos where they use x-rays to line up the hips. If the SI Joint is out of place, won't the hip be lined up improperly?
It shouldn’t be a problem as the amount it is out of place would be small. Have a chat with your surgeon.
Hey guys. Thanks for the information and the advise.
I had bilateral hip replacement at age of 35 and 36. Its been 2 years since i last had the surgery on left hip (unsure if it is anterior, posterior or lateral) , and it was in Germany. Issue is majority of the communication with my doc was done by my gf at the time ( who wouldnt speak to me since break up and i find it hard to get hold of my doc since leaving Germany ).
Long story short, what i would like to know is - Is there anything i am not allowed to do after 2 years since last surgery ? ( I see people going back to cricket at age of 50 after hip replacement and i am here, still not fully mobile - mainly as i struggled to get physio and right recovery straight after the last operation / break up( was a complete mess- having to move my stuff and find a new apartment n crutches)... I still get pain on joint after 5000 steps - maybe its because my muscles are still weak ?
Hi DJ Hesh. Sorry about the messy break-up. Yes weakness can be an ongoing issue. We advise common sense with respect to return to activity. No high impact or extreme range of motion. Good luck!
Talking With Docs thanks for the advice Doc. What do you mean extreme range of motion ?
Hi DJ Hesh. So extreme flexion - knees to chin. Severe internal or external rotation. Hope that answers your question.
@@djhesh80 you can look up dos and don'ts online. If your still having weakness after 6 months get physical therapy. Pt is the best place to evaluate how well you are doing post surgery and what you need to do to build your muscles back up. Good luck. Had both hips and one knee replaced. Pt is key, after good surgery, of course.
My friend at 87 is just about to have her most problematic hip replaced, she will need both done. She originally thought it was post-polio syndrome until she was almost immobile, and a surgeon said she needs both done as socket worn flat and possibly a knee done as well. What I worry about as I will be with her after the op for a while, is having the 2nd hip not good
as well, if she will have extra problems. Should she have a stand-sit recliner? Will her ability to get back walking a bit be far more difficult with 2nd hip needing doing? Any advice?
It can be tricky for the first couple of weeks but with a walker and medication usually is doable. Slow and steady. Best of luck to you both
Can anyone explain to me how they repair the abductor muscle (the gluteus medium) in the Lateral Approach and what are the movement limitations in the post-operatory period in the first 4 weeks and later? Thank you
Hi Hector. We sew the two edges of the tendon back together. Usually no repetitive abduction for 6 weeks and hip precautions for 6-12 weeks
Doctor!!!!!
I got medial malleolar fracture and fibular fracture!!😭😭😭
And at hospital I've gone through a surgery!!!!!!
How can I get rid of pain!!😭😭😭
They used 7 screws !!!!!!
Will they remove the screws later?????
Plz reply!!!!!!!!
Hi Badal_Super Models. Best way to get rid of pain after ankle surgery is ice, elevation and pain medication. The screws will likely stay in forever which is ok. Unless of course they really bother you in the future. Good luck with your recovery!
After anterior right hip replacement surgery my right hip is larger than my other side and my rt foot is slightly rotated out, to 2 o'clock. I have extreme pain as well.
Is this normal?
Hi alex. This is not uncommon but may improve with time. Best of luck. Thanks for watching and subscribing
I’m 3 weeks post op for posterior approach for hip replacement and so far I’m doing well except today I’m experiencing some pain in my groin area is this common at 3 weeks really did not have any pain in my groin prior to sx?
Hi Tracey. This is not uncommon. It would be concerning if it continued to get worse over time or was severe and if so probably best to see your surgeon. Thanks for watching and subscribing if you did
For someone expecting multiple hip replacements in his lifetime (Perthes), does one approach make subsequent surgeries easier to perform? Thank You
what about burning the nerve root heads to stop the hip pain to avoid hip replacement, i had my right hip completely replaced and i would like to try burning the hip nerve root heads for my left hip? what do you think, good or bad idea?
Doesn’t seem to work according to the research
Thank you for the informative THR video. I had my right hip replaced 4 years ago with the posterior incision. . It was AGONY! I was unable to sit without excruciating pain for weeks. I was basically bed ridden as i could only lie flat. Sitting on the toilet was torture.. Its taken 4 years to grow the huge sagging pocket out of my buttocks , be able to ride a bike without my butt aching badly but I still have a lot of hot burning nerve pain over the scar. My hip also clicks and clunks which im sure isnt normal!
Hi Deb. Sounds like quite the jounrney. Sometimes there is residual pain or clicking. If it is really painful or bothersome it is not unreasonable to go back and see your surgeon and get an xray to start. Hope that helps. Thanks for watching and good luck!
I need a total hip replacement on my right hip. I have a BMI of over 60, which from my 2 opinions from doctors has been a big fat no, until I lose the weight. Each time I have asked the doctors how much do I need to lose and each time they have not given me an answer. I am in server pain 24/7 and now have to rely on my family to help me with normal simple tasks like getting dressed. Both of the doctors I saw do the anterior approach, and didn't seem to want to discuss potsterior. In your video is the first time I have even heard of the third approach. To your knowledge is there doctors out there that will perform the surgery with an elevated BMI. I have had a recommendation from a different type of doctor to contact a teaching hospital, that they may have up to date knowledge that would accept me for surgery. Thankfully I live not to far from Chicago which has Univery of Chicago and Rush Memorial. At this point I have lost 30lbs on my own and I'm commited to keep losing. Do you suggest any type of the three approaches for me, and do you think trying to contact the teaching hospitals will help? I have watched many of your videos, not just hip stuff and I love you guys! Not only are you very informative, but you make the information fun! Keep up the great work. Thanks in advance for any feedback. Deanna😊
Thanks Deanna. Teaching hospital is a great idea as they have expert anesthetists as well. Having an elevated BMI does raise your risk. Some centres have cut off of 50 and others lower. Our advice is try to lose one pound at a time with exercise and healthy eating. Slow and steady. Consider getting some professional help as there are many psychological factors involved in weight loss and gain. We truly hope you can find the help you need. All the best. Thanks for watching and subscribing
The surgeons are trained on primarily one of the approaches. In Australia the lateral is not often mentioned. For us it's mostly a choice of anterior (a newer style) or posterior (the older style). Be wary because whatever the surgeon is primarily trained in is the approach they will recommend. This means you may have to use a different surgeon if he/she only specialises in the approach you do not want.
Yes you should ask for what you are interested in. The anterior approach is 50 years old. It is being used more commonly now to help expedite discharge from the hospital and improve function in the first couple of weeks. All approaches are similar by 3 months and beyond
I had bilateral total hip anterior done by the same doc that did a posterior resurfacing to a friend a couple months earlier. Every patient is different.
Yes Knobbies. Thanks for watching and subscribing
Had posterior 8 weeks ago. Incision itches like crazy and I'm still limping. Far better than I was a month ago. But still, I think I have a while to go. Still using the cane outside the home
Thoroughly enjoyed this video, as I am facing this operation tomorrow. It's obvious I'll be leaving the approach my surgeon chooses. However, I would have liked the pro and con explained, as I am not into a fast recovery as much as best outcome. Do realize that most people without medical knowledge would freak out if told the pro and con . HA!
Hi Terrie. The good news is that all of the approaches do well. There are just some subtle differences. Yes a fair conversation to have with your surgeon. You posted two days ago so we hope your procedure went well!
My 82 yr old able bodied mother needs a replacement and her friends are recommending an Anterior. I'm not sold so I'm trying to find information on the differences. She has been told that with the a P THR that she will no longer be able to cross her leg, any truth to this? She also has a good deal of neuropathy to her LE's and Im really concerned about further nerve damage.
Hi Kay. There are pros and cons with all approaches. In general crossing your legs should try to be avoided with all THRs. It does not mean she will dislocate her hip if she does that but there are certain motions that increase the risk of dislocation. Most approaches are successful though. Best of luck in your search. Thanks for watching, subscribing and sharing with someone if you did.
@@TalkingWithDocs Thank you!!!!
Im due a hip replacement in a few months..i drive a utamacic im i still safe to drive???
After 5 weeks typically but everyone is a bit different. Thanks for watching and subscribing
June 2, 2021 Home on the 3rd with posterior.
Congrats She Who Cries Out! Thanks for watching, subscribing and sharing with someone if you did.
Good overview. Steroid injections no longer provide relief. Bone on bone. My wife’s surgeon is going with lateral or anterior small incision (forgot which) and she will not be under general,anesthesia, just regional. Just wondering if this anesthesia method is common for THR right leg. She has COPD under control with meds. Otherwise she is a healthy 82 year old. One surgeon, who we rejected, told her it was unethical to do a THR on anyone over 80. Any reason he would say this if all medical clearances were obtained?
Hard to say John. Yes regional is best. Especially for those with lung disease. Not sure why he would say that. We have operated on patients as old as 95. Age is a number. Health is more predictive. Best of luck to her! Thanks for watching and subscribing
Hi Doc's ....given that the video is 5 years old, how about an update on which approaches are most common now?
I had a lateral THR on 9/20/21 and I have an abnormal gait. The pain has subsided but I have about a 4cm height difference. I can’t even stand straight. When I do try and stand straight one foot is lifted off the ground. I had to purchase shoe lifters because I’m so unbalanced. The doctors keep saying it will go away but I just done believe that it will. I’m just so worried, I’m just 25 and it’s embarrassing, I can’t even wear heels anymore 😔 I just don’t know what to do.
Hi shante. Often it is from the pelvis and will improve with time. If they are concerned they can do an xray that will measure leg lengths to assess any potential difference. Good luck. Thanks for watching, subscribing and sharing with someone if you did.
I would like to know if the 90 degree rule is it for life or just for 3 months? I appreciate your answer.....
We advise 3 months but in general there are restrictions for life to avoid extreme range of motion. Thanks for watching, subscribing and sharing with someone if you did.
I have had so much pain in groin and hip.
When x-rays were done, surgeon said I have lost some cartridge, but I still have some. He said since I wasn't bone on bone my success rate would only be 75% . I am pretty healthy 63 year old women.
What are your thoughts?
Hi Cindee. So we advise patients to consider hip replacement when they have severe pain that affects their daily living and they have exhausted non operative treatments. It is a very successful operation in the right patient. Hope that helps. Good luck to you. Thanks for watching and subscribing if you did.
@@TalkingWithDocs Thank you.
Have you ever done a HReplacement on someone who was not bone in bone?
( still had some cartlidge)
I have exhausted all therapies, shots, steroids, 2, 4 week rounds of PT, antiinflammatories, so I am very willing to do HRS.
I'm just curious to the
"some cartlidge" vs no cartlidge/ bone on bone
possible outcomes. (Generally speaking, I know everyone's different)
Would they be the same?
or would the cartlidge present, interfere with the success?
Hello Docs, had ana acetabular reconstruction 10 months ago and then had THR just five days ago. My question is, following that THR, what are the post surgery conditions that am supposed to follow and how long am I going to fully recovery?
And please, tell me the medicines that I have to use after the surgery!
Hi Makingason. So those types of instructions need to come from your surgeon. It will often take 6-12 months to fully recover especially in the setting of acetabular reconstruction. Best of luck to you. Thanks for watching and subscribing if you did.
Had bilateral with lateral approach and couldn’t be happier. Recovery was dueable. Thank You Docs for all you orthopedic surgeons do. These surgeries gave me my life back. 🫂 and thank you’s to y’all.
Enjoy it Sharon
I had the lateral hip replacement. My scar is 9 inches long. I watched it be done on you tube and they said it would probably be a 4 inch scar. Why was mine 9 inches long. My hip still hurts and I limp and it's beenn 9 months.
Hi Linda. Hard to say. If difficult sometimes the incision has to be extended. We would say 6 inches is normal. Thanks for watching and subscribing
Loving all
Awesome
I had a new total left hip replacement 20 days ago. The hip feels great and I am sure it went well. However, the heel on my left foot is numb with pins and needles sensation. It was like this on the day after the surgery. I cannot feel my left heel. It's numb and tingly. I see my consultant in 3 wks and will obviously mention this to him. I would like to know if anybody has heard of this happening to other people that have had hip reacements. I am walking better but reluctant to put my foot down because it's numb.
It can be related to the spinal or the surgery. It will often improve with time. Hang in there
Love then! "Trust your surgeon to help you make the best decision for you." Sadly, my surgeon left and my new surgeon uses a different method. He made the decision based on what was best for him.
What causes the fatty lump some people get after a THR around the incision? Is the posterior approach more likely to cause this and can it be avoided? Is it permanent? I don't want to be stuck in 'Mom jeans' forever after ... ;-)
Hi Kat59. Some of this can be related to scarring and the adipose tissue that is present in this area. It is not just the posterior approach but potentially more likely due to the location of the incision. Mom jeans are cool now! Thanks for watching and subscribing if you did.
@@TalkingWithDocs no they are NOT!!! ;-)
Good morning Doctor, may I sak a question the hip damage can the bone grow back?
Hi Tracey Ann. The cartilage can’t grow back. If the bone is broken it can grow back. Thanks for watching and subscribing
Am so greatful to hear back from you thanks a lot, I have a next question though. I am a sickle cell patient my Doctor said that There's mild flttening of the femoral head. Subchondral sclerosis and join Space narrowing present. IMPRESSION
1. Flattening of femoral head avascular necrosis.
2. Moderate to severe Osteoarthritis.
Doctor can it grow back if it like this or I of to do surgery am looking forward to hear from you Doctor.
Thanks a lot doc for answering my question god bless you.
Should a patient who is more active have a hip replacement with a larger head?
Hi Donald. Part of that decision depends on the size of your pelvis but larger heads have been shown to be more stable. Thanks for watching and subscribing
So is posterior lateral approach, the rear side access to the joint? It gets confusing in terminology. Chicago surgeon lingo.
Hi Ann. Likely means posterior. Good luck. Thanks for watching and subscribing
How does a MPA differ from posterior or lateral?
Hi TheAsiavol. So the MPA or mini posterior approach simply uses a small incision and less muscle dissection than the standard posterior approach. Posterior differs from lateral in both the skin incision and what muscles are released to access the hip joint. Hope that helps. Thanks for watching and subscribing if you did.
Thanks for the reply. So the MPA is the same as posterior approach and the only difference is the size of the incision. You mention the cutting of muscle. Will the cut muscle regrow and become as strong as before the surgery? How are the muscles reattached? My doctor insists on an MPA approach due to his experience and expertise. Can I expect to enjoy the same experience with my new hip in 12 months as those who had the Antererior approach? Or will the posterior give me limited movement or mobility?
what video talks about Metformin ??
Hi anne. It has metformin in the title. Released a month or two ago. Thanks for watching and subscribing
Get the Stryker Mako Robotic Hip Replacement Surgery. Fastest healing and most precise
Hi Lawrence. Yes there is growing evidence particularly for surgeons who have lower volumes to use navigation or computer assisted surgery. Thanks for sharing. Thanks for watching, subscribing and sharing with someone if you did.
That’s the one I am getting in April but posterior . I hope I do well. I canceled once but I can not live in this pain any longer . Hope your doing well.
Had posterior THR in 2001 and now looking at THR for my right hip that is severely arthritic (wear and tear). Question: which procedure has better outcomes with range of motion (long term) ie: hip flexion/extension, abduction. (My left hip has done really well, however, I do have ROM issues due to reciprocal inhibition)
Hi Mr Blue Sky. So that is a tricky question to answer. All procedures typically have good range of motion. Femoral head size can affect stability. The way a patient heals can also affect range of motion. Best to discuss with your treating surgeon. Best of luck to you. Thanks for watching and subscribing if you did.
I’ll be having a left hip replacement in about 8 weeks time and I’m terrified! It’s just the thought of what happens during the procedure.
I’ve had many broken bones and motorcycle injuries without issues but for some reason this one scares me…
That's not uncommon. Hang in there
I had THR almost 8 wks ago. I am progressing well. I like you was nervous ..I was able to go into rehab after for 12 days where I had physio 2 times a day for 8 days. So thankful for that as I have 22 stairs to get up to my apt so getting the confidence to do them confidently was awesome. I have started pool therapy and it is helping.. especially if you have other joints with OA.
Praying all goes well..each day is better and a little easier then the day before . You've got this !
@@pamwedel3462 you’re a star! Thanks for the encouragement.
By the way, I go in on Wednesday coming. 16 august.
Will definitely be praying for you Walter_steve... Keep us posted please
Can i drive while waiting on hip replacement?
Yes Dinah. Be careful. Thanks for watching and subscribing
Thank you
I do
I heard with the anterior approach, it is more difficult for the orthopedic surgeon to see what he is doing, and thus hip dislocations are more common after the operation.
Hi Donald. There is some truth to that. The incidence is still very low though. And that is more an issue during the learning curve of a new approach. Thanks for watching and subscribing
I wish you were doing my surgery
That is so nice to say Nancy. Best of luck. Thanks for watching and subscribing if you did
The 7 common approaches to the hip are direct anterior, posterior, anterolateral, lateral, mini-posterior, two-incision and superior. A surgeon skilled at each of these will choose the direct-anterior for most patients. The benefits are in the faster early phase recovery without activity restrictions. Most patients will also appreciate the enhanced cosmetic appearance of a 3 inch incision that can be hidden in the front crease of the hip.
Agree completely that the best approach is the one your chosen surgeon is best able to perform in an expert fashion.
I will disagree on the obese patient. The direct anterior approach remains the same surgical field regardless of patient size. High BMI patients can often be done safely and in fact easier through a direct anterior approach.
Hi Dr Palmer. We would think it would be a challenge you to get a 60mm acetabular implant in through a 75mm incision. Also our lateral approach patients go home same day or next day and often do not require significant amounts of narcotics thanks to advancements in anesthesia for sure.
Thanks for watching.
Can I sit down with the Posterior Approach immediately after the surgery? To sit down on a chair normally or I would have to sit sideways by not putting any weight on the side of the incision
Hi Crooked Clown. We do not routinely perform the posterior approach but you can likely sit down. Best to discuss with your surgeon before. Good luck. Thanks for watching, subscribing and sharing with someone if you did.