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Posterior Approach

Posted , 13 users are following.

sarah22500
sarah22500

People keep telling me the PA is the old way and it takes a lot longer to recover due to the fact the large muscles are cut. I’m told the AA is far better for a quicker recovery as the muscles are simply held back.

I’m due the PA as my surgeon says he much prefers this way to get easier access to the hip. Anyone had this method recently??  Thanks

0 likes, 42 replies

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  • RichardKen
    RichardKen sarah22500

    Posted

    Dear Sarah

    If you have been on this forum for a reasonable length of time I think you will have seen that with the posterior approach there do not seem to be many issues following the surgery and only a very small chance of nerve damage.

    With anterior I've been aware of a worrying number of people who have nerve issues following hip replacement surgery.

    I strongly believe that the posterior is generally a better option because all things being equal the surgeon has less constrictions which has several benefits.

    1. Less stressing as more room due to the longer incision.

    2. Better visibility of the operating site making for the possibility of doing a better job as the surgeon can see far better and get at everything.

    3. Due to the more open working space the surgeon does not have restrictions on the length of the stem of the prostheses that can safely be used.

    4. Nerve damage less likely.

    With approaches such as the anterior approach and other approaches where a smaller incision or two incisions are used it is not possible to physically insert a full length stem.

    The shorter the stem the greater the loading of the femur and if your bones are less strong this could be an issue in the future.Also the shorter the stem the less area for the bone to lock onto the stem meaning potentially less stability and security of the stem.

    So what about speed of recovery which is what many are obviously concerned about. I can only speak for myself having had two hip surgeries both posterior.

    The first one was twenty years ago at age 55. I've posted here a number of times regarding this so will just say that I only needed one stick when I left hospital and got rid of it in a couple of days and was back to an office job in just about a week, driving in three.

    No pain meds after leaving hospital and no recovery issues. I count myself as having been fortunate and thank my excellent surgeon .

    My recent revision of that hip resulted in a quick recovery at 76 but not as rapid as the first for a couple of reasons known to the regulars here.

    Hope all that may be of help to you and others.

    Cheers, Richard

    • sarah22500
      sarah22500 RichardKen

      Posted

      Thank you again Richard for a very reassuring opinion. I know for a fact that my bones are definitely not strong so what you described seems like the better option for me. I’m just getting a bit jittery as I still have that darned cold ( no temperature just shivery and runny nose) in case my op gets cancelled again.
  • joanne79383
    joanne79383 sarah22500

    Posted

    Yes, I had posterior 5 weeks ago and no muscles were cut.  That's old school, they just move them out of the way now for both AA and PA.  My recovery was fast, the scar isn't bad and PA does give the surgeon easier access, which is better.  

    • ptolemy
      ptolemy joanne79383

      Posted

      Hi Joanne, that is interesting, perhaps that is why I had no restrictions with the posterior approach. Also I did not have the heavy leg people talk about. After the op I felt as if the hip was my own and I had never had the op. As Richard says the majority of people on this forum had the anterior approach and a lot are quoting problems. 
    • sarah22500
      sarah22500

      Posted

      Hi again Joanne, how do muscles get “moved aside”? Surely once you cut and come to the muscle layer itself you HAVE to cut it to see what’s below it, ie the hip etc etc? 
    • sarah22500
      sarah22500 ptolemy

      Posted

      Wow that sounds amazing ptolemy. It’s the heavy leg feeling I was fully expecting to have to cope with. Maybe I will be as lucky as you.......
    • ptolemy
      ptolemy sarah22500

      Posted

      Hi Sarah, I still lie in bed feeling amazed that I have an artificial hip inside me. It feels so like before.
    • RichardKen
      RichardKen ptolemy

      Posted

      Dear Ptolemy

      I think perhaps you have misread what I wrote or maybe I was not sufficiently clear.

      I do not know what is the proportion of people on this forum who have had the anterior approach as opposed to the posterior one, but I do get the strong impression that very few have had issues with the posterior approach. On the other hand there seem to be rather a lot of people who having had the anterior approach have had nerve related issues.

      On a closely related subject, some weeks ago there was a thread started by someone who was very excited by the claims for the Superpath method. He had his surgery carried out by the inventor of this method mainly I think because it was promoted as having a very quick recovery time but I think he posted that he had a setback and I've not been aware of any further posts. The Superpath is a small incision method BTW and I'm aware of a couple of posters here who had a very bad experience of this method done by the same surgeon.

      I would caution care if considering any medical procedure that relies on ambitious claims supported by fancy web sites and high profile surgeons.... Just saying!

      Cheers Richard

    • ptolemy
      ptolemy RichardKen

      Posted

      Hi Richard, I did understand you, it was probably my bad English!! The posterior approach is tried and tested and gives easier access for the surgeon as far as I can see. There has been a lot of hype with the anterior approach, I think private hospitals particularly seem to use it almost as a marketing tool. Also the French seem very keen on it. There has been an enormous amount of bad press about the Superpath method. It does seem the inventor is spending a lot of his time training other people on it though. I am not really sure what the selling points are over the anterior approach apart from possibly a smaller scar. Because my scar is lateral posterior it can very easily be covered up anyway, not that it is that large.
    • RichardKen
      RichardKen ptolemy

      Posted

      Dear Ptolemy

      Thanks for your posting and your interesting comments.I think some surgeons and private health care places take advantage of the vulnerable "trigger" points, for example with the Superpath I think they say the joint is not dislocated.

      Many people hate the idea of pulling the joint apart of course but you cannot carry out the hip replacement without doing this but they cut off the ball before removal. Same difference!

      Then there is the no cutting of muscles feature but they fail to say that with a small incision it's a hell of a job to move the muscles far enough to poke around inside a small working space.

      Then nobody wants to be immobile for weeks so they promise that patients will be back to normal in days with no restrictions, but this is far from the reality in many cases.

      Finally guys you will have a smaller scar...for the younger ladies this is another big sales point.... perhaps.

      As I see it these are the sales features that are put forward to get patients onboard.

      Sorry if my thoughts offend or upset anyone but it's my cynical or practical side coming out!

      Happy days everyone.

      Richard

    • ptolemy
      ptolemy RichardKen

      Posted

      Hi Richard, totally agree. There was an article in the Daily Mail about some guy who had had the Superpath and how he was able to do all these things afterwards. From what they said I think I had done better with my old fashioned posterior approach. This guy was using crutches for three weeks. Personally I would have thought cutting the ball off before removal was open to more problems that the dislocation system, particular with tiny incisions. I still do not know why I had no restrictions with the posterior approach though, but hey ho. 
    • RichardKen
      RichardKen ptolemy

      Posted

      Dear Ptolemy

      Thanks for the information.  I googled Daily Mail Superpath and total hip replacement and up came the article you mentioned.    Interesting how the operation is full of words to remove any concerns anyone might have!     'After 12 days, I needed only one crutch and none at all after three weeks'   The patient looks like a pretty fit 47year old guy to me who I would have expected to be walking well without any issues with conventional posterior hip surgery in the same time.

      I'm only mentioning all this to try to bring some reality to the various claims that are propagated.

      Cheers, Richard

       

    • ptolemy
      ptolemy RichardKen

      Posted

      I must admit, I thought the article was quite downbeat for the Daily Mail. The guy had not leapt out of bed the following day and carried on as a lumberjack as before!! As you say, the fact he was 47 and with a super new system you would have thought he could have done better than the rest of us.
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