THR Approaches input: Direct Anterior vs. Direct Superior with Dual Mobility cup (aka Superpath)

[thepuckhead]

Hips are also widely understood as the main place our bodies store Grief.

Wow - that's fascinating! Now the tears that come when I place my hand on the hip during meditation/mindful PT make a lot more sense. I've got one the books you recommended on reserve at the library - looking forward to learning more about the mind-body connection. Learning is a form of healing.

I often just want to rush to the end of a challenge and get it done. My brain works fast and I want everything around me to keep up. Feeling trapped or stuck or held back is fruuuuuustratingggggg for me.

I hear ya 100%. When I'd go to hockey workshops and watch demos of the various shots, my mind would get it instantly. I'd understand all the mechanics and the tips, but then....my own body, with its unique talents and limitations, trying to translate what my brain had processed into proper motion? Oh, that is a long and painful translation sometimes.

So glad you're sharing your journey - I'm learning a lot from your posts!

Take care -

 

[LaKarune]

Hi everyone, looking for some advice again. My surgery is scheduled for 4/20, preop scheduled for 4/5 which is all coming up quickly. However, I’m dealing with some absurd and demoralizing logistical problems at my house that are making me wonder if I need to postpone. Long story short — the rain we’ve had in Los Angeles has been so extreme that it’s actually damaged the house, and the downstairs room I need for surgical recovery is one of four rooms that may need extensive repairs and remediation. Our homeowner’s insurance took almost a month to come evaluate the damage, gave us a ridiculous assessment that they say they’ll adjust based on GC estimate, and contractors who came last week still haven’t submitted bids for the repairs. I’m feeling really stuck here. There’s a large chance we will have to move out to get the rooms repaired, and based on how long it has taken to get any movement from insurance and contractors, it seems entirely impossible for the room to be ready in three weeks. Im in more pain as the months wear on, and don’t want to lose more muscle postponing this surgery, but having the stress of insurance, banks, and construction at the same time Im trying to heal from surgery just feels… yeah, impossible. If I postpone surgery, there’s maybe a chance all the house stuff would be done in time, but then again, maybe it wouldn’t. I don’t feel like I can put my energy into the house and the surgery at the same time. No family lives locally, so if I opted to stick with the date I’d likely need to find a rental house for a month (or a few) and leave my hubs the extra work of dealing with the house and kids. Nothing is fine, everything is terrible. Advice requested. Thanks in advance. :(

 

[Layla]

Good Morning LaKarune,
How unfortunate. I am so sorry you're facing the damage to your home on top of surgery / recovery.

Postponing your THR could possibly involve months of increasing pain as your hip continues to deteriorate. While there is pain in recovery, you're at least heading in the right direction as you regain strength, stamina and basically your life.

Personally, I feel I'd keep the surgery date even though the situation is fluid, deciding on where I'd stay if displaced due to repairs / remediation beginning before, or soon after surgery. At this late date, it seems more likely the work won't be completed, if even started, I think you'll be surprised by how quickly you establish a routine and can comfortably care for yourself. While your surroundings may be unfamiliar in the first few weeks, if it becomes necessary to vacate your home right before or right after surgery, I do feel you'd do just fine.

Best Wishes for your comfort and mental clarity as you make decisions and move forward. Please stay in touch and know that we're here for you.
@LaKarune

 

[AllieBucks]

I think I agree with Layla. Most likely you will be feeling pretty good after about 2-3 weeks since you are in great shape. You can schedule your contractors to start work around that time. If the rooms are livable, then you will be ok. All of the remodeling takes forever so go ahead and get going on that new hip!

 

[djklaugh]

@LaKarune Ugh! What a horrid situation! I agree with the above about getting the hip done. And suggest "thinking out side the box" about where to recuperate. You and hubs need to wrack your brains for any friend, relative, neighbor, coworker, parents of friend of kids who might have space for your family for a few weeks while construction and rehab is going on - or who are going on vacation and need a house/pet sitter, or who have an available rental. Or check the website NextDoor for your community and appeal to local folks for short term (relatively) inexpensive rentals nearby. And do ask your home owners insurance if they will pay for your temporary relocation while renovation is going on ... since the damage was from a natural disaster they might do so.

My experience with in home construction projects (albeit this was in 2005) was that once the contractor has a signed contract and knows what needs doing and has all the parts and pieces to do it with, then the work goes quite quickly. I had major (ie tear down to studs) renovation of kitchen and bathroom (with necessary upgrades to wiring and plumbing) plus new roof done ... and once all the i's were dotted and t's crossed the actual work only took 2.5 weeks. Total mess while that was going on but the results were wonderful!

Good luck to you!

 

[LaKarune]

Thank you @Layla @AllieBucks @djklaugh - super appreciate you all weighing in and reminding me that in the long term, healing is the #1 priority. The room I’m meant to recover in is pretty badly damaged (ceiling especially), so if the work isn’t done in time for surgery, I will need to find a different place to move while recovering. I want to be “nesting” right now in preparation for recovery, so not having that space is making me feel very rootless and anxious. The rental market here is absolutely bonkers expensive, which adds more stress to the equation. I’ll explore some options for rentals in the next few days and hopefully that’ll contribute some clarity. You’re all right in that the best case scenario would be to keep my date and get to healing sooner rather than later. It would stink for this to be a financial decision over a health outcomes decision, but that’s a looming possibility. Will explore and let y’all know… meantime still waiting for these contractor estimates :(

 

[KittensMom]

I found this forum because I was agonising over the fact that my surgeon only did posterior, and the internet was telling me I would be crazy to go with this approach in "modern days".

Everyone's recovery is different, but today, day 9 after my surgery, I've twice forgotten that I need crutches and have been launching off the sofa and walking around the apartment without them.

The only restriction I got for after the recovery is over was no extreme yoga. And if I want better longevity, then I probably shouldn't think of picking up running as a hobby.

I will echo what many people here I am sure have said already: go with a good surgeon that you can trust. Someone that will be open to discussing your goals after the surgery and will give you a realistic prognosis. And (advise from my physio who has seen it all) someone that can tell you exactly how they will do their absolute best to make sure you will come out on the other side with a leg that is the right length

 

[LaKarune]

Thanks @ChickensMom. I’m so happy to hear that you’re feeling so well after just over a week PostOp. I’m going with a surgeon who uses a “mini-posterior”/ minimally-invasive approach. He uses a MAKO robot to assist, and he uses a dual-mobility prosthetic that should give me my best shot at both the stability and flexibility I’m looking for. I am hopeful that I will be able to dance again once I’m on the other side of this journey.

 

[LaKarune]

Ok so quick update— I bit the bullet and have rented a little recovery house for myself. I’m going to move in next week to get comfortable there before my surgery on 4/20. Keeping the date. My Mom is coming down to help take care of me (she lives a few states North) and the rental is close enough to home that my family will be able to see me regularly. It’s so much expense but I decided that peace of mind and body is going to be my priority. Thanks again for all your voices gently encouraging me to keep my date and get on the other side of the healing journey.

 

[Jaycey]

@LaKarune Sounds like a well thought out plan. Well done! I look forward to following your recovery journey.

 

[sfbaylover]

Hey Allie!! Dr. Yun's outcomes are so good that I haven’t crossed him off my list.

How are you doing in your recovery so far? Do you have a recovery thread I should follow? Curious about where you were @ physically right before your surgery vs how far you’ve come in the first four weeks, if you care to share. ☺️

I’m ready to schedule my hip replacement surgery, but I’m conflicted as to which surgeon to use. I, too, have consulted with Dr. Yun ( this was back in 2019) but also have seen (and last saw) Dr. Jay J Patel at Hoag Orthopedic Institute in Irvine, CA, and both surgeons are highly regarded and very experienced.

But for me this whole hip-replacement business is a huge deal and I therefore want to make the best decision in regards to not only the surgeon himself but also the hospital (facility) in which to have surgery. And I’m honestly uncertain about how to proceed.

I know that Hoag orthopedics is nationally ranked and is one of the higher-performing institutions for hip replacement in the nation. And Dr. Patel comes highly recommended. But so does Andrew Yun. And both surgeons use the direct anterior approach.

My main concerns with hip replacement is leg length and stability/mobility, and I’m sure either doctor is probably equally proficient in performing hip replacement surgery and producing an optimal result.

I will say that Andrew Yun was not an overly friendly or amicable kind of guy when I met him; he was kind of brusque and direct — but ok. Dr. Patel has a better bedside manner, imo.

But as long as I get an optimal result — that’s all that matters. I do think that perhaps I get a bit too hung up on surgeon ratings and scorecards and whether or not a surgical facility is nationally ranked or not. I’m sure it can matter, but perhaps it’s not the only thing that matters.

 

[LaKarune]

Hey Allie!! Dr. Yun's outcomes are so good that I haven’t crossed him off my list.

How are you doing in your recovery so far? Do you have a recovery thread I should follow? Curious about where you were @ physically right before your surgery vs how far you’ve come in the first four weeks, if you care to share. ☺️

I’m ready to schedule my hip replacement surgery, but I’m conflicted as to which surgeon to use. I, too, have consulted with Dr. Yun ( this was back in 2019) but also have seen (and last saw) Dr. Jay J Patel at Hoag Orthopedic Institute in Irvine, CA, and both surgeons are highly regarded and very experienced.

But for me this whole hip-replacement business is a huge deal and I therefore want to make the best decision in regards to not only the surgeon himself but also the hospital (facility) in which to have surgery. And I’m honestly uncertain about how to proceed.

I know that Hoag orthopedics is nationally ranked and is one of the higher-performing institutions for hip replacement in the nation. And Dr. Patel comes highly recommended. But so does Andrew Yun. And both surgeons use the direct anterior approach.

My main concerns with hip replacement is leg length and stability/mobility, and I’m sure either doctor is probably equally proficient in performing hip replacement surgery and producing an optimal result.

I will say that Andrew Yun was not an overly friendly or amicable kind of guy when I met him; he was kind of brusque and direct — but ok. Dr. Patel has a better bedside manner, imo.

But as long as I get an optimal result — that’s all that matters. I do think that perhaps I get a bit too hung up on surgeon ratings and scorecards and whether or not a surgical facility is nationally ranked or not. I’m sure it can matter, but perhaps it’s not the only thing that matters.

Hi! It has been a huge deal for me too, and I did an incredible amount of research before deciding on my surgeon. It sounds like you’ve settled on the Direct Anterior approach, which is one big decision under your belt.

I don’t know anything about the surgeons in the South Bay; I live on the West side in LA so I only met with surgeons who were pretty close to my home. From my research and conversations with medical peeps (incl my primary doc and PT), Dr. Yun is considered technically top of his field for the Direct Anterior approach. He’s definitely not personable, but for most people it doesn’t matter, bc you’ll do most of your Post Op visits with his PA, and what matters most is technical precision in the surgery room.

That said, if Dr. Patel is super highly regarded as well, I’d recommend choosing the surgeon who has a practice that’s closer to your home, or if that’s a pretty close call, then consider things like the quality of the hospital they work from, their surgery schedule, and how your nervous system responds to the doctors and staff. From the sound of it, you’ll be in excellent hands either way. Let me know what you decide!

 

[Jamie]

@sfbaylover ... both of the surgeons you are considering are good. I suggest you pick the one who makes you most at ease with the surgery and recovery process.

 

[Layla]

I do think that perhaps I get a bit too hung up on surgeon ratings and scorecards and whether or not a surgical facility is nationally ranked or not. I’m sure it can matter, but perhaps it’s not the only thing that matters.

You're right @sfbaylover it's not the only thing that matters.
You've suffered emotionally and physically for far too long. It's heartbreaking. You mentioned elsewhere on the forum what an impact this has had on your life, dealing with the physical limitations since you were young and how it's affected your confidence and self esteem. Your condition has not allowed you to engage in activity you dreamed of partaking in, nor live life to the fullest. There is no time like the present to schedule your first THR by selecting one of the surgeons you mentioned as you've narrowed your search. You are as young as you'll ever be and sadly none of us are promised tomorrow. Schedule the surgery now and start focusing on a brighter future of fulfilling your dreams without the limitations you're currently struggling with. We'll be your loudest cheerleaders, available for support and encouragement whenever you're in need. Move forward in confidence, you can do this!

 

[Layla]

Hi LaKarune,
Only one week to go for you! I hope you have your recovery nest pretty well stocked and you have your eye on the prize. In the blink of an eye you're going to be home beginning your healing journey and onto a beautiful Summer 2023 without the wretched pain and limitations of a deteriorating hip. I'm excited for you, you're going to love this! I will look forward to following your healing journey on the flip side if you are able to find the time to share progress with us and those following behind.
Best Wishes and Happy Thursday!
@LaKarune

 

[thepuckhead]

Ok so quick update— I bit the bullet and have rented a little recovery house for myself. I’m going to move in next week to get comfortable there before my surgery on 4/20. Keeping the date. My Mom is coming down to help take care of me (she lives a few states North) and the rental is close enough to home that my family will be able to see me regularly. It’s so much expense but I decided that peace of mind and body is going to be my priority. Thanks again for all your voices gently encouraging me to keep my date and get on the other side of the healing journey.

I am so glad to hear this. A special rental house all for your recovery. That is really taking care of yourself. And really good that you will have someone with you. Sounds you are pretty darn well set and I look forward to hearing how you do after you're relieved of the arthritis. Keep us posted! I think you're going to be amazed at how much better you feel.

 

[LaKarune]

Thanks @thepuckhead and @Layla -- yes I'm in my rental house and very glad I got in early. I had to make some modifications to my recovery bedroom - the bed was too low, so I got a box spring to lift the bed up to my booty-level, got a tall shelving unit ($10 from Craigslist!) to keep my clothes so I don't have to bend down to get socks, other stuff like that. Nice to be able to make these adjustments before I go under the knife.

It's Saturday night and my surgery is this coming Thursday. Feeling... pretty scared... but I have some mind/body work to do that I've been putting off that I feel sure will increase my confidence and ease my nervous system a bit.

I have to decide what anesthetic method to use. I have been pretty convinced that I want general anesthesia, but the surgeon and my primary doc are both recommending a spinal only. They both say I'll be able to get moving more quickly and therefore have a better recovery doing the spinal. Do you all know if this is an evidence-based recommendation? My nervous system is SO shot and general anesthesia sounds like a method that will calm it all down and allow me to truly relax, but I am operating from ZERO experience here. Is the ability to get up and walk ASAP after surgery truly connected to faster healing and better overall outcomes?

 

[Layla]

Hi LaKarune,
Feeling anxious is normal, we all felt it to varying degrees. You will get through it and once they're prepping you they can give you something to calm you and it does help. Time moves quickly in prep. They keep conversation casual and light which is reassuring and comforting. It will be just another Thursday at work for them and they want the same perfect outcome as you and strive to make that happen.

In my experience they had me up and walking within a couple hours and luckily I was fine with it and did well. It does help reduce swelling to move and it also reduces the risk of developing a blood clot. In addition, it increases blood flow to the area which can promote healing. What I felt was key for me was Exparel which is a non opioid analgesic that was injected into the area before closing and slowly wore off over a period of 72 hours. My pain was managed very well. I did A LOT of icing.

We normally recommend you get up and walk once every hour or two, for five minutes or so in those early days and normally a trip to the bathroom, or to the kitchen to get a drink or snack takes care of that.

Just think next week at this time you'll be in you're recovery nest healing and on your way back to all that you love and have been missing due to a deteriorating hip. You're going to love the result this surgery brings. I'm excited for you!
@LaKarune

 

[LaKarune]

Hi LaKarune,
Feeling anxious is normal, we all felt it to varying degrees. You will get through it and once they're prepping you they can give you something to calm you and it does help. Time moves quickly in prep. They keep conversation casual and light which is reassuring and comforting. It will be just another Thursday at work for them and they want the same perfect outcome as you and strive to make that happen.

Somehow the way you put this feels soothing already. Can I call you Mom?

In my experience they had me up and walking within a couple hours and luckily I was fine with it and did well.

Did you have the spinal vs the general, then?

It does help reduce swelling to move and it also reduces the risk of developing a blood clot. In addition, it increases blood flow to the area which can promote healing.

Copy, so they're truly recommending a best practice then when they say do the spinal, sounds like.

What I felt was key for me was Exparel which is a non opioid analgesic that was injected into the area before closing and slowly wore off over a period of 72 hours. My pain was managed very well. I did A LOT of icing.

I'll ask about Exparel once I meet the anesthesiologist, which probably won't be until the day of my surgery.

We normally recommend you get up and walk once every hour or two, for five minutes or so in those early days and normally a trip to the bathroom, or to the kitchen to get a drink or snack takes care of that.

Do I do this at night too, or try to sleep as long as possible?

Just think next week at this time you'll be in you're recovery nest healing and on your way back to all that you love and have been missing due to a deteriorating hip. You're going to love the result this surgery brings. I'm excited for you!

Thanks again for encouraging me to really imagine being on the healing side of the pain. I have to do some meditations to truly integrate this vision, but I am definitely glad you encouraged me not to postpone it, despite the ridiculous situation with my house.

 

[Gloucestergal65]

@LaKarune - I dithered over spinal vs general too and in the end went for a spinal. I just wanted to be completely out of it and I was. On the subject of getting up at night, I found that at first I was up every couple of hours needing the bathroom - I think they fill with you with fluids to keep your blood pressure up and it takes a few days to clear the excess fluids from your system. I just slept whenever I felt I needed to which often wasn’t at night. That’s when Netflix comes in handy and that’s when I discovered all the brilliant advice from people on Bonesmart.