Does it matter what approach your THR is?

Hi Kimberley ....so glad your replacement was a success.  Yes I will go do a search, just that when reading here I didn't see much about it although maybe I didn't look enough .  I guess it doesn't really matter as at the end of the day I need it done I was just curious the different ways.  I'm also not sure because of my previous condition if it rules out some options as well.  I know I'm bone on bone and I'm sure the consultant my socket is rotated a bit too, so maybe that makes a difference.  

Many thanks for your reply 

Lizbet x

Thanks Lizbet 

Try using the 'Google' search engine.  Type in Google, then search 'lateral hip replacement' using that site.  There's quite a bit of information available online.  Let me know if you need more help.

Hi Linda,

I'm so sorry the battle you've been having with your hip replacement then dislocating it! I do hope you are starting to see the end of the tunnel and have the nightmare behind you!

Question: I am also having the anterior approach on May 15th. Is dislocating the hip more common of a risk with this approach or is the risk the same with any type?

How do you think you dislocated it?

Thank you

Betty

Thanks for your kind words Linda... it's interesting to read everyone's experiences .  I'm sorry your hip dislocated after your operation, it's frustrating after you going through such a big operation.  Glad your now on the mend .  I'm not sure what the outcome of my operation will be given my history which is similar with the dysplasia as yours.  Do you still have the limp or has that improved?  

Take care ... Lizbet x

Thank you Betty! It's been a long recovery. Still not 100%. Still stiff, nerve and muscle pain and muscle weakness. Still limping without cane. I've tried to think when and how I dislocated that hip. Honestly I'm not sure! Thing is everyone says you will know when you dislocate your hip, you'll be in level 10 pain!! Not me! Yes there was pain but I just thought it was part of the surgery. I was still walking and doing the home therapy exercises. Which were a becoming a little difficult. What I did notice was my operated hip was higher, when I laid down I saw that the operated leg was way shorter even before surgery!! I should of gone in then but everyone kept thinking since I was still walking and exercising nothing could be possibly wrong!! The ONLY thing I can think of is me twisting. I remember I was in my walker, getting a shirt out of my drawer I was not facing the drawer I twisted to the left pulled drawer open got my shirt then pushed drawer shut and I felt a significant pull in my buttock. It hurt to walk on it for most of Day into the following day then went away. I told this to my therapist who felt like I was ok since pain went away. Also was hard headed about sweeping and mopping. 😩 I was on a dislocation for maybe a week week and a half!! 3 weeks later......😩😖. Dr tried to do what's called a closed reduction, meaning pop hip back without opening me up. The hip ball was caught on backside of cup. Cup became loose as well as stem going into the thigh bone. So dr had to do a revision as he did not like that and felt it better for a revision. I've heard once you have a dislocation and they pop it back in your chances of it happening again are greater. So to answer your question, I really don't think there's a difference in surgeries as to which will provide a lesser chance of dislocation as it is to adhearing to the precautions in the first 6 weeks as it takes that long for the bone to start growing into the new hip. Although I've also heard the anterior approach may have lesser chances. Unfortunately for me I guess I was the odd ball! 😞 Again wishing you all the best for a successful surgery and speedy recovery! 🤗 LD. And come back and let us know how you are doing!! 🤓

Hi Liz! No im still limping. 😞 I'm going on 7 months from the revision. Therapist and dr think it's all due to weakness of the hip muscles. I really have to concentrate when I'm not using the cane to tighten the glutes when I step. That seems to help but it's not easy!! I know my road is longer than others but I'm trying to stay positive and have faith and hope all will get better. It hasn't been easy. I still get discouraged and frustrated and cry....... I think sometimes that I can't do this anymore..... but I'm still here! One day at a time. 🤗🤗. LD 🤓🤠

It sounds like when you were getting your shirt out of your drawer and twisting, especially feeling a significant pull in your buttock, may have been what dislocated it. Or, the sweeping and mopping! It does not seem like it should be so, but mopping can really take a lot out of you!

Again, I hope you find relief very soon and I will come back and let you know how it all went. Thank you and take care, Betty

Advantages of this procedure include:

1. Is considered a more straightforward approach then the anterior, resulting in lesser complication rates.

2. There is significantly less bleeding with the posterior approach, notably reducing the necessity of a blood transfusion after the surgery.

3. There is a faster and more-consistent recovery with the posterior.

4.  Because the posterior is more straightforward, many surgeons think it provides an increased margin of safety for the patient, because the incision can easily be extended if exposure is poor, or if a fracture occurs. 

5.  Because of the straightforward exposure of the femur, there is less risk of femoral fracture or poor implant positioning. Should one of these events occur during a posterior procedure, they are easier to recognize and correct. 

6. Because visualizing the femur is easier, an experienced surgeon can choose the most appropriate femoral implant rather than just the one that is easiest to implant, taking into account the patient’s bone quality, activity level and age.

7. There is less risk of neurological injury.

8. No special surgical equipment is required when performing a posterior.

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. Because the patient is lying on his back, it facilitates using a fluoroscope or moving x-ray throughout the procedure. This does expose the patient to more radiation but can help with component positioning and sizing. There tends to be a lesser incidence of posterior instability with the anterior approach. On the other hand, there may be a slightly increased incidence of anterior instability.

There is a smaller incidence of sciatic nerve injury with the anterior approach but an increased incidence of femoral nerve injury. This is because the nerve is located in front of the hip.

Published by The Leone Center for Orthopedic Care.

Wow! I had a TKR in 2014 so I went to the same surgeon when I felt ready for the THR. He also only does the posterior approach. During the consultation & exam, he found my right leg ( same side as bad hip & knee) was longer than the other and immediately referred me to his partner, who only does the anterior approach, as he felt the surgeon could shorten my leg to "match" the other one better through the anterior approach.

It's all so stressful not knowing really what is the best way to go

Thank you for your valuable information. I'd sure like to hear more success stories from people who have had the anterior approach, but it seems the majority on this forum have had posterior or lateral.

Thank you, Betty

Betty,

The best thing to do is to go to a surgeon that is very experienced in the type of procedure that do.  Yes there pros and cons, but it sounds as though the other surgeon is well versed in the anterior procedure.  I'm sure he's done it thousands of times. 

Have you spoken to the other surgeon?  I'm sure he/she will be able to put your mind at ease

Kim, thanks for the information. I trusted and liked my old Surgeon with 48 years experience. I knew the different approaches but did not feel the need to seek out an Anterior specialist as there are many here in the Chicago and USA area. Maybe more pain recovering from a posterior approach, but after 3-6 weeks no difference. Besides I have a great looking 10" scar that I would not have had with anterior 😀

Steve,

My surgeon has decades of experience, came highly recommended by my back specialist, and after meeting him I felt like I could trust him.  I really think that's more important than a specific type of procedure.  Unless of course, you've advised that a certain procedure would be better for you.... as in Betty's case.     

I have a 5 inch scar on the side of my hip, but my bikini days are well over anyway

Hi Kimberly,

Yes I have seen the other surgeon and felt extremely comfortable with him ( despite the fact he looked to be about 12 years old, but after a certain age most doctors look to young to know what they are doing, ha) Seriously though, he told me he does over 300 THR a year, all anterior approach and like I said, he put me completely at ease with his wonderful bed side manner and knowledge in what he does, so I'm putting my trust in his hands.

If I went with the other surgeon & had the posterior approach, I'd still wonder if I did the right thing! I just need to make a decision and go with it.

Can't wait to be where most of you are, having this behind me and looking forward to enjoying life again without pain & limitations.

xoxo

Your meeting with the new surgeon sounds very positive  I know what you mean about doctors looking so young these days!  It sounds as though he's very experienced, and that's the main thing. 

It won't be long before it's all over with and you'll wonder why you worried so much  Best of luck, and keep us posted.