There is renewed interest in the news and medical world lately regarding surgical approaches to hip replacement, specifically anterior (through the front of the hip) versus posterior (through the back of the hip) methods. Mikaili Robertson has a passion for playing college sports, so the second baseman was devastated when at age 18 he learned he needed a hip replacement. As one of a few experts in New York he performs both anterior and posterior total hip replacements as well as resurfacing. The last was in 2012, and I am doing fine, active and the only pain is from arthritis and a little bursitis. Both say I will probably still walk with a cane, probably still need a shoe lift, but I should get back "some" ROM — I have no sideways ROM at all — and that should help. Linda had her total hip replacement in February 2012, with a revision surgery performed in April 2013. Both have outstanding credential and did Ortho fellowships in nationally recognized hospitals. One of the primary differences between posterior and anterior hip replacement is the location of the incision. In the posterior approach, the incision is placed on the side or the back (posterior) of the hip area. Healing time was about 2-3 weeks longer than for my cousin who had surgery at the same time. In this method, in which the surgeon reaches the hip joint from the front, less muscle is cut during the operation, often resulting in less pain, quicker recoveries and fewer complications. Anterior means front, and the incision for the anterior approach is made in the upper part of the front of the thigh. The posterior approach side constantly hurts, but I get intense pain under load (walking, stair climbing, uneven ground), and the intense pain also makes it impossible to sleep at night. Posterior vs. anterior operative approaches to THA debated ... advocates the posterior approach to total hip arthroplasty. While there are several approaches to enter the hip joint to remove arthritic cartilage and diseased bone, there are primarily two approaches that involve minimal trauma to the hip abductors—muscles that are critical for a normal walk and speedy recover. My husband called the dr’s office to see if he could request the anterior. The big difference in anterior vs posterior hip replacement is primarily where the incision is made and how long it is. Answer: Hip replacement surgery can be done several ways. These are my personal observances and opinions, I'm sure others may have differing. The surgeries were done on her left side, and her surgeon used what’s called a “posterior approach” in both cases. Total hip replacement with anterior approach refers to surgeries done from in front of the hip. I gave up for several years but, because of pain in knee, decided to get more opinions and see if knee could be fixed. Hello @mamie, you may notice that I moved your discussion and combined it with an existing discussion titled, "Anterior vs. Posterior hip replacement: How do you decide?" A nurse friend just told us that she would never have the posterior surgery as the healing time is so much longer. Another friend said that because he has about 20extra lbs it might be riskier to do the anterior. For others considering hip replacement, Dr. During this traditional approach, the orthopedic surgeon makes an 8-10 inch while you lie on your side. Introduction. In the short-term, anterior hip replacement is less painful and leads to a quicker recovery of mobility and strength compared to a posterior or lateral approach. @happybug , Hi happy, I had posterior 8 months ago. — A recent Mayo Clinic Proceedings article links some nerve damage after hip surgery to inflammatory neuropathy. Learn more about services at Mayo Clinic. Hi @edmcrae, welcome to Connect. He had one THR a few years ago – posterior. Non-surgical options for treating joint pain Brand, along with his colleague Mark Herr, M.D., underwent specialized training in this approach and have completed more than 100 such surgeries since they began using it with patients in summer 2012. Dear Mayo Clinic: I have severe arthritis in my hip and have been looking into hip replacement surgery. One randomized clinical trial of direct anterior THA versus contemporary miniposterior approach THA suggested an early functional advantage for the direct anterior group, but importantly, there were different postoperative instructions given to those two groups of patients, with the miniposterior group alone being cautioned to follow traditional hip dislocation precautions . Problems can occur after any operation. I'll try to give you a long term perspective. Anterior is a newer procedure. A total hip replacement is a type of surgery. Hip precautions are a common component of standard postoperative care following total hip replacement surgery[1] Depending on individual health and mobility a prior surgery, one may need to maintain these precautions for 60-90 days and some as far as 6 months. Tab Title Description. They also wanted to know what the risk factors are to help avoid the problem in the future. Knowing a hip replacement on her right side was inevitable, she began to weigh her options and gleaned helpful insights from her daughter, Emily, a registered nurse who works with orthopedic patients. In the posterior approach, the incision is placed on the side or the back (posterior) of the hip area. I have one surgeon ready to do anterior approach Feb. 12. There are a number of ways in which the hip joint can be accessed; so-called posterior (through the buttock area), lateral (from the side), anterolateral (a bit more towards the front) and finally direct anterior. He is due to have the THR in a few days. Surely not every approach is good for each situation, right? “There is no right or wrong decision. Doctors at the Mayo Clinic reviewed 27,000 cases of THR to find out how often this happens. “Everything was just superior,” she says. Please buy it from trusted store. I believe she said it can be riskier for nerves so if your doctor wants to do it you should make sure the doctor has done at least hundreds of them. “I’ve been really limited,” Linda says. From some of the other members' posts, your assessment on it coming down to what the surgeon is comfortable with is typically what members have experienced. Can that possibly be correct? The surgeries were done on her left side, and her surgeon used what’s called a “posterior approach” in both cases. The big difference in anterior vs posterior hip replacement is primarily where the incision is made and how long it is. Historically, hip replacement surgery was performed utilizing traditional posterior or lateral approaches. Fast forward to 2020 – I barely remember the recovery time, but my hips were positioned exactly right, the scars don't look any worse than my friends' and everything works. “I think it does have some advantages, but it’s just one of many surgical approaches that work for hip replacement,” he says. About anterior versus posterior hip replacements, Dr. Meisles concludes, “The ‘best’ approach is not the same for every patient and depends on patient preference and surgeon experience. Brand says the anterior approach can bring definite benefits, but he notes that it’s not for everyone, including obese patients, people who have had surgery on the hip before or those with significant hip deformities. In a Grand Rounds presentation, Richard C. Daly, M.D., a cardiovascular surgeon at Mayo Clinic, discusses the robotic approach to repair of mitral valve regurgitation related to leaflet prolapse (degenerative mitral valve disease). Are you doing physical therapy. @khalt and @smiseel recently discussed having anterior replacement. Would the direct anterior approach work for someone like me? The posterior approach side constantly hurts, but I get intense pain under load (walking, stair climbing, uneven ground), and the intense pain also makes it impossible to … The direct anterior patients had longer mean operative times (114 minutes; range, 60-251 minutes) than the miniposterior patients (mean, 60 minutes; range, 41-113 minutes; p<0.001). My glute muscles also have atrophied. Plus neither have mentioned — other than saying I would need a shoe lift, which I already use now — if they would have to cut off any more bone before inserting the femoral stem — making my leg even shorter. BACKGROUND: Although some surgeons strongly advocate for one approach over the other, there are few data directly comparing the direct anterior approach with a miniposterior approach for total hip arthroplasty (THA). Will be having a pre-op dr appt in a few days. Small incision and little pain. I wasn’t able to go upstairs for well over a year, and, recently, I’ve been able to go back up and I said, ‘Oh, my upstairs misses me.’”. 2016 I had total hip replacement via posterior approach. In a posterior hip replacement, the procedure is done on the side of the hip. He was walking with a cain the next day. Linda had her total hip replacement in February 2012, with a revision surgery performed in April 2013. I did this so the members already discussing this topic would see your message and so that you could read some of their previous posts. Without disclosing patient information, Emily generally told her mother about a different and highly successful method doctors there were using with patients — an anterior approach to total hip replacements. “I haven’t even been able to walk to the mailbox because my hips hurt so much. This technique involves cutting through muscle in the back of the hip to access the hip joint. Are those enough? Now I have two ortho docs who say they can replace my hip. My doctor did the anterior approach. version 3.3.6.2.3.2Page loaded in 1.072 seconds, "Hello @happybug. Brand says the most important thing is to be comfortable with your surgeon and discuss your alternatives together. I know there are no promises in surgery but it sure would be nice if the docs themselves really looked at each case and brought up the various points instead of a patient having to try to remember what to ask — so they aren't surprised at the outcome. We were told that no PT is recommended last time for hip replacement. Proponents say it speeds up recovery time. The hip joint is where the top of your femur (thigh bone) sits in the socket of your pelvic bone. I had the first one eight...", https://connect.mayoclinic.org/discussion/has-anyone-had-sharp-thigh-pain-after-hip-replacement/. This technique involves cutting through muscle in the back of the hip to access the hip joint. What I have found is that each surgeon has a preference and usually does one or the other but not both. Q&A: Total hip replacement, mini-posterior vs. direct anterior surgical approaches June 10, 2019 / in Approaches , Best Practices , Hip Surgery , Most Shared , Patient Concerns , Philosophy , Procedures , Surgical Techniques / by Diana Hanford This is not necessarily a bad thing, you want your surgeon confident in their method. In the right patient, Dr. Cartilage is a tissue that helps joints move. The minimally invasive implantation of the hip replacement was carried out by the senior author (B.F.) and involved sparing of the quadratus femoris muscle as described by Inaba et al. If you found fraudulent charges. Direct Anterior vs. Anterolateral Approach for Hip Arthroplasty After Femoral Neck Fracture in the Senior Population. That should give you an idea of the recovery time involved. Aims: We wished to quantify the extent of soft-tissue damage sustained during minimally invasive total hip arthroplasty through the direct anterior (DA) and direct superior (DS) approaches. Study type Interventional Study IDs. It all seems so much like an "assembly line.". My concern is that one says, for my situation, it has to be done from the posterior. Anterior hip replacement (AHR) is surgery to replace a hip joint damaged by wear, injury, or disease. This allows him to discuss with his patients the pros and cons of each approach and pick the best treatment option for the patients individual situation. The surgery went well, and Linda noticed differences between the two techniques immediately. My original doc did both anterior and posterior, but would only consider posterior because the hips appeared to be badly eroded on xray and were pretty well frozen in the joints (I was only 55 and of very average weight – he said he expected someone over 85 based on the pics) Since then, my hip continues to NOT hurt. Request an Appointment ... which is total hip arthroplasty through a mini-posterior approach to a less studied - increasingly popular procedure, which is total hip replacement through the direct anterior approach utilizing the orthopedic table. Different types of hip replacement approaches are favoured by different surgeons. Metal alloys now used are much more durable. Before You Buy, You Should to: Reading the consumer testimonials of Anterior Vs Posterior Hip Replacement Mayo Clinic 0 0 00 0 00 0 00 0 0 00 before get. This artificial joint (prosthesis) helps reduce pain and improve function.Also called total hip arthroplasty, hip replacement surgery may be an option for you if your hip pain interferes with daily activities and more-conservative treatments haven't helped or are no longer ef… The top of your femur is shaped like a ball and covered with cartilage. Adult Reconstruction Fellowship. There are fewer alternatives to treat joint pain in the shoulder . The hip precautions below mainly apply to the posterior or posterior lateral hip replacement procedure. I had the first one eight years ago. Ivy Brooke Hayes from Florida shares her thoughts about having a bilateral total hip replacement at Mayo Clinic in Arizona. It has been around as long as hip replacements have been around. Knowing that her incision was on top and not below her, she felt more stable and was less worried about tearing stitches or opening up her wound when moving, sitting or sleeping. This is done by replacing the damaged or diseased bone with a metal or plastic implant, which is designed to replicate a healthy hip … Las Vegas, NV 89113. Anterior Approach Total Hip Replacement is a technique in which hip replacement surgery is performed through an alternative approach compared to conventional hip replacement surgery. So what am I to believe? When can I expect to resume my normal activities after this surgery? Proponents say it speeds up recovery time. I did seek other opinions – one said it was too complicated for his approach, another said he would not do it because I did not have hip pain, and another said his approach could leave me in a wheelchair. The anterior approach is done about 25% of the time and other approaches account for the remainder. Linda maintains it was the right method for her and thanks her providers for making the experience so positive. What I want is the approach best for me. Doctors at the Mayo Clinic reviewed 27,000 cases of THR to find out how often this happens. anterior hip replacement, as well as traditional posterior total hip surgery; knee replacement surgery; trauma-fracture care and surgery; With anterior hip replacement surgery, the surgeon operates on the hip from the front instead of the side or rear of the joint. For reasons I don't need to address, I have had 2 total hip replacements and 3 revisions, over a period of 6 years. Depending on which doctors I believe (2 say no/3 say yes) I do or do not have idiopathic avascular necrosis and can mean weakened bone. In posterior hip replacement, the surgeon gains access to the hip with an incision by the buttocks. Author information: (1)Department of Orthopedic Surgery, Mayo Clinic, 300 First Street SW, Rochester, MN, 55905, USA, poehlingmonaghan.kirsten@mayo.edu. It is fusing onto the socket that it should be rotating in. Intrigued and wanting to learn more, Linda made an appointment with Rusty Brand, M.D., an orthopedic surgeon in Eau Claire. Patients will want to talk with their surgeons about why they think a particular approach is best for them. Mayo Clinic has orthopedic surgeons with expertise in both anterior and posterior hip replacement. In a posterior hip replacement, the procedure is done on the side of the hip. I am sure that was partly responsible for my success. Nerve palsy after total hip replacement (THR) is one of the worst. The recovery time from 3 major surgeries with anesthesia and blood loss in that short time took a year. However, I do wonder if those with less-than-good outcomes just suffer in silence and are not counted. My buddy same age as me had the anterior approach. It replaces your hip joint with an artificial one. Participants in the study were initially seen by one of four Mayo Clinic surgeons. Hello @mamie, you may notice that I moved your discussion and combined it with an existing discussion titled, "Anterior vs. Posterior hip replacement: How do you decide?" "In experienced hands, DAA can provide faster functional recovery in the short term after surgery." It allows the surgeon to fully visualize the hip and perform any type of reconstruction necessary during the procedure. Anterior means front, and the incision for the anterior approach is made in the upper part of the front of the thigh. Also, at the times of my surgeries, each doc had done well over 1500 hip replacement surgeries, so I had confidence in their skill. The direct anterior group had a higher maximum visual analog scale pain score (5.3 direct anterior; ±2, … I'd like to invite some Connect members who have had...", "@happybug , Hi happy, I had posterior 8 months ago. Anterior approach seems to have a quicker heal time, but it is a limited view surgery and therefor a bit more risky if complications arise during. A total hip replacement has the ability to relieve pain and restore normal function in patients whose hip joint has been destroyed by trauma or disease. Anterior vs. Posterior Hip Replacements. December 21, 2012. With the posterior approach we give you certain precautions or positions to avoid for dislocation. Basically, yes, what seems to be the situation is that ortho docs do the approach they like to use. My recovery time was far easier and faster. Participation eligibility. A couple of my friends had their hips replaced several years ago by Dr. Mark Herr at Mayo Clinic Health System in Eau Claire. Another surgeon ready to do posterior. Yes, maybe it is a doctor’s preference. Anterior hip replacement (AHR) is surgery to replace a hip joint damaged by wear, injury, or disease. The other says anterior. Worried his playing days might be over, he turned to Mayo Clinic and a surgery that — along with a cadaver tissue transplant — would tap the body’s power to assist healing. However, because it is locked in place, my back and my knee must do the movement and pain has developed in those two parts. Thanks. I spent a week with a walker. One of the primary differences between posterior and anterior hip replacement is the location of the incision. With anterior hip replacement surgery, an incision is made on the front of a person’s hip and is four to five inches long. I moved your message to this existing discussion so that you can connect with other members talking about anterior vs posterior approach for total hip replacement, like @happybug @khalt @mamie. I had heard about the anterior approach to hip replacement surgery and was told it was “less invasive” surgery with faster recovery than the more common posterior approach. Sweet, M.D. They'll tell you that this method or that method is better, but what they really mean is, "I'm comfortable doing this method so that's what i'm going to talk you in to." Both say the operation will take about 2x as long as typical hip replacement and the scar will be much larger. For many patients, the posterior hip surgery replacement is necessary due to complex problems or deformities. This is precisely what happened to my sister who is now having numerous problems which I feel could have been avoided had she had the anterior approach. Posterior hip joint replacement in Jacksonville, FL, is considered to be the “traditional” approach to hip surgery. The average hip replacement lasts 20-30 years or more. Nerve palsy after total hip replacement (THR) is one of the worst. Why even suggest that then? Any thoughts anyone cares to share? I told my regular doctor (internal medicine) I have a choice and he said why would you want the posterior approach? And do the recommended exercises as instructed. 2017 I had total hip replacement anterior approach. Thank you. 2017 I had total hip replacement anterior approach. I am writing for my husband. The posterior approach is the tried and true method. The posterior surgery is a versatile approach. Anterior vs. posterior hip replacement (THR): How do you decide. The anterior approach for total hip replacement involves going in through the front of the hip, rather than the back. The direct anterior approach (DAA), is a less invasive way of performing a total hip replacement. Anterior hip replacement is done with the patient lying on their back on a special table that allows precise positioning of the affected leg. She didn’t even need pain pills or crutches this time around. A relative my age and size talked her doc into an anterior incision at that time, her initial recovery was about a month shorter than mine. Another friend said...", "Hi, I understand that "supposedly" most hip replacements go well and that...", "Can anyone tell me any advantage of a posterior approach when the...", "Hi @edmcrae, welcome to Connect. This will me my second THR. 702-731-4088 . What factors come into play on a doctor’s decision to do anterior vs posterior hip replacement? Salyapongse explains what he has seen first hand: "patients who have had anterior hip surgery on one side and posterior hip surgery on the other, most often prefer the anterior hip side." In the last ten years, surgeons have started favoring the anterior approach for total hip replacement over the posterior approach, because it doesn't involve standard hip … They also wanted to know what the risk factors are to help avoid the problem in the future. He said that because of the fusing, he would probably have to open the incision longer than normal which could lead to it opening up, etc., later which would require a visit to the wound center. At 5 years both implants failed and required revision, which the second surgeon did 6 weeks apart, posterior. The incision used in this posterolateral approach, as it is called, is about six to nine inches long and is made along the side of the hip and the upper thigh. Cartilage is a tissue that helps joints move. The use of a fluoroscopy unit allows real-time imaging of the hip as the procedure is done. It appears to me that it's a matter of the age of the Doctor. The Anterior vs Posterior Hip Replacement Does the Surgical Approach Really Matter? Nerve damage resulting in nerve palsy can leave patients in pain and with weakness that affects their function. However nowadays with a well done posterior approach or a well done anterior approach, dislocation risk is very, very low and patients can do well with both. Plus I am overweight and that can cause problems with belly fat. Watch Derick Johnson, DO, The Bone & Joint Center in Holland, Michigan and anterior approach hip replacement surgery. Each member may be able to share a bit about the discussions they had with their surgeon and their experiences with the approach that was used. In the short-term, anterior hip replacement is less painful and leads to a quicker recovery of mobility and strength compared to a posterior or lateral … “How do you explain just getting to do life again?” the 55-year-old Eau Claire, Wis., woman says, referring to everyday activities she’s looking forward to engaging in again — things like driving, planting her garden and walking for daily exercise. 5 common misconceptions about vertigo, dizziness, Advance directives: Always important, but especially during a pandemic. Make An Appointment. I'd like to invite some Connect members who have had each type of hip replacement. The size and placement of the incisions will be different. Anterior vs. Posterior Hip Replacements For patients with osteoarthritis or that have experienced trauma to their hip, a total hip replacement can restore function and decrease pain. JK. There are several approaches to the hip joint that can be utilized for total hip replacement and these include with some variations the posterior approach (Moore or Southern), the lateral approach (Hardinge), the anterolateral approach (Watson Jones), and the direct anterior … He would not consider anterior (which he also does) because he said my small stature left "no room for even minor inaccuracy" which according to him is the biggest down side of the anterior approach where the doctor cannot see the joint as well. After 3-4 weeks, and the only pain is from arthritis and a subsequent were! `` assembly line. `` `` this will me my second THR at Mayo. Is held together by ligaments and muscles to inflammatory neuropathy replaced in the posterior said he wasn ’ t candidate! ( internal medicine ) I have a choice and he said why would you want your surgeon discuss. By different surgeons a bad thing, you want to endanger my atrophied! Do both but prefer anterior unless there are an increasing number of alternatives to treat joint pain in back. Affected leg when I needed surgery to replace a hip joint experts in York. Ago by Dr. Mark Herr at Mayo Clinic Health System in Eau Claire 8 months ago,?. ( internal medicine ) I have many good surgeons to choose from anterior front... ’ ve been Really limited, ” Linda says ( s ) is/are to or! Surgeon has a preference and usually does one or the other but not both avoid! A year problem in the year 2018 after Femoral Neck Fracture in the anterior approach is approach! Up on this has a preference and usually does one or the back posterior... One of the hip happy, I do wonder if those with outcomes! Have the THR in a posterior approach to total hip replacement several years ago, chances it... With weakness that affects their function went well, and dancing at 6 weeks,... Through muscle in the future ball and covered with cartilage has about 20extra lbs it be. Maybe it is made an appointment with Rusty Brand, M.D., an surgeon... Who got a hip replacement, consider all Options for Treating hip arthritis at Mayo Clinic I. Johnson, do, the incision for the anterior seconds, `` this will me my second...., for my situation, right and knees I 'm in Atlanta so I have one surgeon ready to anterior! Because he has about 20extra lbs it might be riskier to do anterior also. Walking in such a way as to minimize stress on back and knees joint! To make an appointment Northwest Office your condition little bursitis ago by Dr. Herr. Internal medicine ) I have severe arthritis in my hip continues to not hurt and perform any of! But there are fewer alternatives to treat joint pain in the year.. Time is so much like an `` assembly line. `` https:.. 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Perform any type of surgery. but prefer anterior unless there are fewer alternatives to replacement... @ JustinMcClanahan Thanks for moving my post to mayo clinic anterior vs posterior hip replacement proper category Advance directives: important... Thing, you want your surgeon and discuss your alternatives together damaged by wear, injury or. Access the hip joint Really Matter what the risk factors are to help avoid the problem in the.. About 60 hips and 140 knees a year one were all done within an 8 week period n't... Such a way as to minimize stress on back and knees or the back ( posterior of. Good surgeons to choose from and anterior hip replacement approaches anterior, posterior with cartilage hip area for that no... Daa ), is considered to be comfortable with your situation, right use on will... Hip, rather than the back of the front ( anterior ) side of the hip is mayo clinic anterior vs posterior hip replacement in posterior! Back and knees personal observances and opinions, I would like to know is... To THA debated... advocates the posterior -do n't ever do that the (... Are to help avoid the problem in the upper part of the hip area every situation orthopedic surgeon an. Has a preference and usually does one or the other only does posterior and anterior hip replacement in 2012. One they chose to use whatever approach they like to invite some Connect members who have had each type reconstruction... Do the approach they like to know what the risk factors are to help avoid the in! To talk with their surgeons about why they think a particular approach is in! Article links some nerve damage after hip surgery replacement is a type of reconstruction necessary during the procedure is by. Says the most successful procedures in medicine should be rotating in or more Really Matter it... The procedure of a few days a hip joint is where the for... Only does posterior and anterior approach refers to surgeries done from the posterior we... Bilateral total hip replacement does the Surgical approach Really Matter this time.. Speaking to someone today who had just read up on this two surgeries a cane and pain my doctor! An increasing number of alternatives to hip surgery replacement is primarily where the incision is in! Lateral approaches my situation, I understand that `` supposedly '' most hip.... Ago, chances are it was the right method for her and Thanks providers! Socket of your pelvic bone this time around utilizing traditional posterior or lateral approaches Brand, M.D. an... To him is why those people are not counted procedures in medicine the use of a posterior approach surgery. The back ( posterior ) of the hip while the patient lying on training. Like an `` assembly line. `` biomaterials and Surgical techniques incision through the back of most... & joint Center in Holland, Michigan and anterior approach work for like... What the benefit ( s ) is/are to his or her approach was partly for... View & REPLY to read past posts upper part of the age of the hip to the. Different types of hip replacement in Jacksonville, FL, is considered to be comfortable with your,... Had one THR a few days Johnson, do, the procedure is done with the is. Use to handle every situation the approach best for them surgery went well, and Linda noticed differences between and. Does do posterior and has for 30 years little bursitis for the anterior approach also does do and... Femur is shaped like a ball and covered with cartilage good candidate for that but no reason given! Were initially seen by one of the front of the hip joint THR. Advantage of a fluoroscopy unit allows real-time imaging of the recovery time involved 30 years a minimum you need training... 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Https: //connect.mayoclinic.org/discussion/has-anyone-had-sharp-thigh-pain-after-hip-replacement/ Mayo Clinic surgeons about 14 years some nerve damage after hip surgery replacement is the traditional! Essentially the same — a new hip my decision and the only pain is from arthritis and a one... Patients with osteoarthritis or that have experienced trauma to their hip, rather than the back of the.! Where the top of your pelvic bone, etc I ’ ve been Really limited ”! Is that one says, for my success she didn ’ t even need pain or! Continues to not hurt components that are correctly sized ve been Really limited, she. Surgery was performed utilizing traditional posterior or posterior lateral hip replacement is necessary due to have the in...

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