Anterior or Posterior - Decision Decision

It's been 3 years since my left THR (and my posting on here). I had the posterior approach and the recovery time seemed long. This site BTW proved to be invaluable at that time. So here I return....my right hip is shot, I've lost about 2 inches in leg length, barely walking with a cane and am on a daily diet of percocet. I need it replaced. I saw my surgeon today and he was less than enthusiastic about the anterior approach. He doesn't do them because after all his classes he attended and research he did he believes it to be more hype than fact plus it holds more risk for nerve damage and fracturing. However, he's more than happy to do my THR posterior in April. There are a couple of ortho surgeons down the street from his facility that have been doing anterior for a few years now, but they're so popular I may not get an initial consultation until April and surgery further down the road. Is it truly worth the wait?

Hi Kathy. I had anterior approach and recovered very quickly. I have been very happy with the procedure. That said, having read what you are going through now, I do not think I would wait if you have someone who can do posterior sooner rather than later. As Jamie and Josephine have said, in the end, the outcome is the same.

I've decided to wait and see a surgeon who does a ton of direct anteriors. I found out today he has my records now (which had to be transferred from other OS' facility) and my gp's referral. I should find out when my appointment is with him tomorrow. I have the pain under better control now but still am anxious to get this done so I hope its soon :prayer1: Lou, what, if any kind of restrictions did you have after your surgery? With the posterior, I had a 90 degree rule for weeks which was stressful.

Hi Kathy. I went home with no restrictions. I could sleep on my stomach (although I was too uncomfortable the first two weeks or so to do that) or cross my legs. The big advantage is PT can start sooner, and more aggressively. My PT told me that she was able to give me exercises at 4 weeks that should would normally be giving to patients 8-12 weeks after surgery. I was completely finished with PT in about 6 weeks after the surgery. I cut back from 2 appts a week to 1 in four weeks after the surgery.

If there was one disadvantage there was a small nerve (lateral femoral cutaneous nerve - diameter of a strand of hair) that was severed. I have some numbness towards the bottom of my quad. But I had numbness around the scar when they operated on my leg when I was 18 years old that took about 5 years before it went away! So, it is no big deal for me and I am told it resolve within a year. Also, my surgeon explained to me there was a risk of this happening. It wasn't a big surprise.

I had a posterior approach and began outpatient PT at the clinic exactly one week after my THR. I was discharged by the PT five weeks later. So, I am not sure that I would agree that timing or duration of PT are important differences between surgical approaches. Especially considering that most THR patients outside the US recover perfectly with no formal PT at all. My understanding is that they just do basic, non-aggressive exercises at home and end up just as recovered as we do in the US.

I do think it's great that you are meeting with the other surgeon, so you can weigh your options and make an informed decision. Good luck with that and do keep us posted, okay?

Hi Kathy. I had a posterior approach and sure there is some rehab but nothing I didn't expect. I asked my OS about the anterior approach and he said that there is greater risk of nerve injury with that approach. Not a great risk, but he felt why take any risk? So what if it takes me 2 weeks longer to climb back into my wheel loader. I felt he was right, it comes down to risk management. And I really really liked my OS. My thoughts here are to find the OS you like and trust and feel good about, who has a good reputation. Let him choose the approach and the appliance. My incision is but 4.5 inches long. I was walking that day. Best of luck to you!

Hi - I've had both approaches - one on each hip - and they were different - short term and long term I feel anterior is the way to go - w/ that being said - I was in so much pain pre-op that I could not have waited another day for either of my surgery's....

so, if I knew what I know now, I definitely would have wanted the anterior approach, however I probably would not have been able to wait for it due to the pain I was in.

And, to b fair, the lateral approach has been fine and I really don't even know I've had the hip replaced at all anymore - so whichever you choose its going to b ok!!!

xoxo,
Linda

I had a posteria THR four and a half weeks ago and I was just happy to have a great surgeon and to go along with what he did best. My recovery has been very quick, I was actually moving around my bedroom and bathroom without my crutches at just over a week, not for long periods, just if i had put my crutches to one side, and it was just easier to walk a few steps without them.
After three weeks I was happily moving around the house without any aids, although I wont go outside without them until I get the all clear from my surgeon at my 6 weeks appointment, although he did say before i left hospital, he was expecting me to come back without my crutches and to walk up and down the corridors for him.......no worries !
So I think either approach is good, its horses for courses, we all recover at different times and the end result is no more pain ! But good luck with whichever option you go for .

I had the posterior approach with an excellent surgeon who does 500+ hip replacements and-or resurfacings per year. Just as an example, he did 9 the day of my surgery. I think he has done anteriors before because I saw it listed on his resume, but he's not a big fan of them for whatever reason--I didn't question him about it because I just wanted to have a surgeon who was very experienced at hip replacements and was willing to go with whatever he recommended for me.

As far as recovery, my surgery was 12 noon; I was out of bed for a brief period that evening--mostly just standing and took a couple of steps to relieve some muscle spasms; up and walking in my big private room (LOVED that room!!) and short distances in the hall with my walker the 2nd day; getting fully dressed adn walking about 250 feet to the PT room and doing group PT twice the 3rd day and was declared independent in my room and for short walks in the hall end of the 3rd day.

Discharged to rehab (my preference because I live alone and was uncomfortable coming home this soon after surgery) 4th day. I had 4 days of OT and PT at the rehab and walked in the halls quite a bit on my own while I was there. Came home, had 3 home PT visits and was declared doing well enough for discharge with no need for outpatient unless I wanted it or my surgeon wants me to do it. Just keep walking and doing my hip exercises.

I walk out to see my horses (about 300 feet) at least once every day and putz around the barn and the horses; play ball with my dogs outside; and go walking at a nearby church gym or on the sidewalk, depending on the upstate NY winter (which has been thankfully very mild). I'm doing a few light horse care chores now; have done my own housework since returning home (except for the first vacuuming--too difficult to do that while supporting myself with the walker), cooked my own simple meals, taken care of my cats and dogs (although I do have someone else clean the litter boxes because of the bending involved). I'm a little less than 5 weeks out and I've been able to go for brief shopping trips since the 3rd week and driving since around the 3 week mark, and the hip is doing great and hasn't had a problem from the time it landed in my body. I will admit that I did overdo things in the beginning and had a period of severe exhaustion, but the hip was fine during all of this--the rest of my body just felt awful.

The 90 degree restriction is a bit of a pain in the butt, but I've learned to work with it and it's become pretty much normal for me at this point. In fact, I'll probably have to "unlearn" it when I get released!

My opinion and just my own personal opinion and situation--I wanted a SUPER good surgeon working on me. The approach was not important to me as long as the person doing the work was very good. My surgery went off without a hitch. It took less than 1 hour, I lost very little blood, my incision didn't have a bit of drainage after the first few days, my leg length has been fine since the get go. My surgeon could probably do this procedure in his sleep--he is THAT experienced. The end result was the most important factor to me. I could put up with some restrictions in the beginning. I just wanted to be GREAT for the rest of my life.

The bottom line is that I went with what felt right to me ... and you should do the same, whether it's posterior or anterior that you choose. Listen to your gut. Maybe even make a "pros and cons" list about the procedures and the surgeons you talk with.

Good luck and whatever you decide, I hope you are able to get a surgery date soon because you sound like you are in such pain. I remember those days--not fun!

Dorothy

Decision made!

I can't thank you guys enough for all your feedback. I saw the new surgeon this past Tuesday and was totally impressed. He's been specializing in hip replacements for the past 20 years, is totally up on the new technology, and sold me on direct anterior approach. Anyone I've talked to said he's the top doc in the facility (and they have a lot of docs in Concord Orthopaedics). He's going to do a ceramic, plastic and metal assembly. My left hip is metal on metal. I'm scheduled for May 8.

BTW I printed out the list of questions to ask your surgeon from Josephine's sticky. He asked where I got them, I told them about this site and he wrote it down. Imagine that - a surgeon broadening his information horizons.

I hope my surgeon doesn't identify me when I see him. Probably cart me off to the funny farm :th_heehee::th_heehee:

I think you should select a surgeon not an approach. I picked a surgeon who has a good track record with some of my farrier friends and let him pick the approach. He likes to do what he calls the anterior-lateral approach. If he is happy I am happy LOL.

I think if I was shoeing his horse he would let me pick the shoes and how to hold the foot and what kind of nails to use etc.

Yes, George, I quite agree with you about ultimately choosing a surgeon rather than approach. It was only that after my first surgery I found this site and learned about anterior approach. When I went to another surgeon to inquire about it, I found myself feeling much more confident that I was putting myself in the best hands. Comparison to first surgeon came to play - first surgeon is an all around OS and doesn't do that many THR's in a year. The second surgeon specializes in only hips (including revisions) and has been for the past 20 years. He does many many many replacements each year. Plus, he answered all my questions, showed me the device he would install, showed me my X-Rays and how they measure for the device and how they align for leg length while on the table, etc. I didn't get that first time around. Like you, I like to know that I'm putting myself in the hands of the expert.

Hi Smja

Leo is my 18 year old cat. The avatar is not her but it looks exactly like her. And yes, she's a she with a male name. I named her before we knew her gender. She was like a Leo the lion stepping all over her brothers and sisters to get out of the kitten box! Anyway, she's a bit senile, blind, and deaf now but provides me with tons of love and laughs still. And that's a good distraction from all the pain and discomfort.

I'll be lurking about as I'm sure I'll have more questions.