Anterior or posterior. Not sure which way to go

[alexthecat]

I've had several hip surgeries, involving posterior, lateral, and anterior incisions, with and without post-operative restrictions. I found little, if any, difference among my surgical incisions. If I had to voice an opinion I would say that my anterior incision was slightly more problematic.

I'd never heard any of the advertising hype around anterior THR until I found BS, months after my last anterior incision. That hype has always seemed ridiculous to me. It's not something I would have arrived at based on my own experience. Actually, I was very happy to hear my OS say that it would not be necessary to reopen the anterior incision for my THR.

Understand though, that my main priority with THR was to regain the ability to walk. I'd spent the previous nine months in a wheelchair or on crutches, as I had one surgery after another. I was more concerned about long-term outcome than short-term restrictions.

 

[sissy46]

Since I was told the long-term outcome would be the same with either approach, I was definitely interested in having the least short-term restrictions.

But, alexthecat I think you and I are comparing apples and oranges. You'd been through a heck of a lot over a long period of time, with much loss of mobility, whereas my problem had cropped up rather suddenly. As I've had an easy and rapid recovery and just about perfect results, of course I'm enthusiastic about the particular surgery I had.

 

[liberatedhip]

I'll just chime in and say that I had anterlateral approach - it happened to be what my OS "does" - he said that he doesn't like anterior because of the risk of nerve damage. With anterolateral you have the benefit of avoiding the posterior precautions while also avoiding the anterior risks. My recovery has been great so far with no restrictions and weight bearing as tolerates. I feel good, putting aside the possibility that my femoral stem component may have slipped... grrrr.

On the other side, my home PT person said that her preference is posterior because she has seen that people having the posterior approach more easily return to or develop a good walking gait, v. anterior or even anterolateral. In my case, I already had shortening in the front muscles, with a lot of accommodation to avoid hip extension, so I think I would have that to work on regardless of approach.

I think it can really be hard and confusing to sort out what the right answer is. Even really good doctors can have imperfect outcomes and every person brings their own hip history and physical situation into the surgery.

My approach when deciding was to go with a doctor I really connected with who also has a good reputation. Go figure that I may have a complication, but I still think that is the best way to go about it - you need to have faith and trust in the person you are relying on for this very big step.

Hope this is helpful...

 

[alexthecat]

As I've had an easy and rapid recovery and just about perfect results, of course I'm enthusiastic about the particular surgery I had.

Actually, I also had a rapid and easy early recovery. Being more than three years post-op, I'm even in a position to talk about the long-term outcome of my THR. Like you, I was also happy and enthusiastic in the early months of my recovery. The minor inconvenience of hip restrictions didn't change that. So, I keep saying that hip precautions were not, in my experience, a big deal.

The thing is that a lot of people show up here after reading sites that are devoted to advertising the anterior approach and promoting inaccurate ideas of other approaches. People get an idea that they need to choose a less experienced surgeon or travel great distance in order to have the anterior approach or that they are doomed to a miserable protracted recovery, if the anterior approach is not an option for them. I think it's worth it to share my real experience of posterior THR as someone who has actually been there and who had a positive outcome, in spite of being a less-than-ideal surgical candidate.

 

[Mbone]

I had posterior also. Mine was left hip so I was able to drive after 3 weeks! I also was able to sleep on non surgical side! The precautions were not that big of a deal! My surgeon was great! My incision is only about 3 inches!

 

[Teacat]

Allow me to also chime in.....I had the posterior approach. I initially wanted the anterior and my OS offered to do it. But I asked which he preferred and he said posterior. He also said he didn't see any recovery differences on his patients comparing the two methods. I trusted his judgement. I have a 4 inch scar and was WBAT immediately after surgery. Also, he gave me no restrictions but I gave them to myself not wanting to mess things up. Like sleeping with a pillow between my legs (I'm a side sleeper and have done so immediately after surgery). We borrowed one of those toliet seats to put over our toilet but actually, it barely cleared the rim and all of our toliets have not been a problem for me. Tomorrow is 3 weeks post op and I have been walking around the house unassisted since 6 days ago. I have also driven short distances since 2.5 weeks but I'm off pain meds and it was my left hip that was replaced, not the right. I'm very happy with the approach I had.

 

[designergirl]

I had the antero-lateral approach and am extremely happy. I didn't choose this approach, I chose the surgeon. The restrictions were no big deal. I didn't go to rehab and managed just fine in my two-story house. I have a great deal of ROM back already and I walk unassisted without a limp. I am 6 week post op tomorrow. I drove at 3 weeks and I had my right hip done. I tested it and there was absolutely no pain moving from the gas to the brake and no pain doing a hard brake. I commented to my surgeon that my incision was long (9 inches) and he said needs the room to do his job well. And a wonderful job he did. The scar has faded considerably and it will be no big deal in a few months. I never had much pain at my incision site. From what I read on this forum, many people that have had the anterior approach are not having the wonderful recovery I am. Pick the best surgeon first and let him do what he does best.

 

[Vida]

The important thing for anyone considering a THR to note is that while some maintain that rehab may be faster or pain may be less with anterior, there is conflicting data. Some studies have found no difference in recovery. I offer the following from the Journal of Orthopedic Surgery and Research, published just a year ago. I personally think this arguments is swings and roundabouts and that there are no guarantees, no matter which way you go. That's why I favour the 'find an experienced surgeon you can trust' route, rather than chasing down someone who does a procedure that may not in fact be right for you. My (antero-lateral) restrictions were a pain only because I was 50 percent weight bearing for 6 weeks, which pushed everything further out. Other than that delay, they weren't a problem.

broken link removed: https://www.josr-online.com/content/7/1/17

 

[designergirl]

As everyone can see even with the same approaches, restrictions will vary. Vida we both had the same approaches and I had as much weight bearing as tolerated. My OS said many of his colleagues doing the same approach have no restrictions, but he likes to play it safe. I chose him and I followed his instructions. I felt if I was going to trust him with my hip, I was going to follow instructions. I almost feel that some of the restrictions gave me peace of mind, letting my hip slowly heal correctly. If I had non, I might have done too much too soon and as we all know, that never turns out well.

 

[Vida]

designergirl To be fair, I had a fracture, otherwise I think I would have been just as spry as you were!

 

[bottomshollow]

A really, really good surgeon that you trust and have confidence in is much more important than the surgical approach. One's individual general health and physical condition also have a very big impact on recovery. Having a positive outlook is important. And not allowing yourself to be manhandled by an aggressive PT after surgery is a must.

But if the surgical approach is really that important to a person, then they are free to shop for a really, really good surgeon they can trust and have confidence in who uses the approach they want.

And regardless of approach, the end result is what will really count when all is said and done.

 

[designergirl]

Vida that's so true, sorry I neglected to take your fracture into consideration.

 

[Poppet]

My personal experience was that I had no preference for one type of surgical approach compared to another... I was going to have an incision. I was going to have a recovery period.

The six weeks of restrictions was a small price to pay (in fact, I slept through most of those six weeks anyway) to be able to walk again.

When I reflect back over the last 16 months since my THR I just delight in the fact that I can walk and I had the courage to go ahead with my surgery which has given me back my quality of life.

Nowadays, I give no thought to the surgical approach or post op restrictions... I marvel at the miracle of the gift my surgeon and his skill has given me..

 

[designergirl]

I feel the same way Poppet The next time I see my OS, I will have a strong urge to hug him. He gave me my life back.

 

[Poppet]

designergirl... I think the title of my own thread says it all.... I am totally besotted with my OS...

 

[Allycat]

I wonder how many patients go to their 6week check up and tell their OS they love him? I know I'm going to
The wonderful man who took my pain away.

 

[Poppet]

You betcha Allycat

 

[clifford149]

Hi ...what a range of views.....to be honest I was not aware of the importance of approach....I was feeding off the mom debate and wanted ceramic on ceramic + minimal invasive surgery....my other concern was leg length increases....my os was based upon a recommendation...I also found out that he regularly publishes in journals....he does around 500 per year....and that stat can be a good indicator of competence...he was also in a top 10 list of UK surgeons....he specialises in a mini posterior....I am full weight bearing...now for 4 weeks...started driving my automatic today.....being sleeping on both sides since week 3....with a pillow....and in 2 weeks should be free of the 90 degree rule

 

[designergirl]

clifford149 it seems like you approached finding the right surgeon the proper way. He sounds like he has great experience in hip replacements, regardless of approach and you are reaping the rewards of that choice. When I chose my surgeon, I also was not aware of the different approaches.

 

[clifford149]

Hi designergirl and hippie friends....I suspect some of us have just been lucky in the os we got for others the process may well be confusing and maybe even frightening....thank goodness for BS and that can be lucky to find..because none of the professionals mentioned the site...I have been telling them....at least I have got my pt to recommend to other of her patients.....