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Does the type of hip surgery matter?

Discussion in 'Hip Replacement Pre-Op Area' started by goblue61, Dec 23, 2018.

  1. goblue61

    goblue61 new member
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    After two years of pain I have finally made the decision to have my left hip replaced. The past year has been difficult with constant pain not allowing me to be active as I like. The last straw was a recent trip to Italy where I was miserable walking each day. I knew the walking would be a challenge during this trip but I felt I could get by with meds which did not work. By the end of the trip I had to use a hiking stick to get around. During this amazing trip I realized I would never be able to do this again unless I got my hip replaced. I have also missed snow skiing the past few years due to the pain and weakness.

    Upon return I received a letter from my insurance company that the surgeon I had seen back in September would no longer be covered by my insurance. This surgeon performed both the Anterior and Posterior approach. I then found another surgeon in the area that I like and trust that my insurance would cover. He was very positive on my recovery and due to my good health I will be back to normal quickly with my activities that are important to me. He explained in detail the difference between the two types of surgery however he only does the posterior surgery. I had talked to a few "friends of friends" that were very happy with the Anterior surgery but have not heard any first hand information on the posterior surgery. My wife wanted me to look for another surgeon who does the anterior approach but I decided to schedule surgery for January 8th with this surgeon whom I like. I also want to get this taken care of early January so I can recover in the winter when my business is slow.

    When asked about the difference in recovery I was told that although many patients/ doctors feel the anterior approach recovery and pain may be a little quicker; the time difference is very minimal and in many patients it is virtually the same.

    Any thoughts or information would be greatly appreciated.
     
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  2. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @goblue61 Welcome to BoneSmart!
    There is quite a bit of marketing hype out there about anterior. But your surgeon is spot on - there is very little difference in the pain levels and the length of recovery. And the end result is the same - a shiny new hip.

    I totally agree with your approach - go with a surgeon you trust and feel comfortable with. This is a partnership and you do need to be able to work with your surgeon.

    BTW my LTHR was posterior. My recovery was longer due to having my hip collapse 6 months before my op. My RTHR was lateral with no restrictions. I was very satisfied with both approaches.
     
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  3. gloveguy

    gloveguy junior member

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    @goblue61... I feel @Jacey is spot-on!

    I’m early in my 4th week of recovery from a RTHR, posterior approach. When I started struggling with OA, about 3 years ago, and found out that I’d eventually need a hip replacement, about 18 month as ago, I started researching online and asking anyone who had any experience for their opinion on how to approach things.

    I’m a “details” person and when I heard people who even wanted to know the brand-name of the prosthetic that each surgeon they interviewed was using, I started down a road of worrying about having to know each and every detail about what each surgeon would do.

    Long story short, I decided to go with a surgeon who I felt the most comfortable with. The surgeon I chose is an hour fldrive from me but right when I met him something clicked. He, and his team, were so thorough with assessing my condition, and letting me know my options, I knew I’d found my guy!
    Going into surgery, I didn’t even know his approach of choice, type of prosthetic, nothing. All I knew was he’s been specializing in THR surgeries for over 35 years, is a lead professor of orthopaedics at the university, performs over 300 procedures per year and, oh yeah, we hit it off right away, lol!

    I’ve come to realize this is a pretty personal relationship and YOUR comfort level is the most important thing headed into this major surgery.

    Congrat, it sounds like you’ve found your guy, too! :) :-) (:
     
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  4. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    100% in agreement with this. Many get themselves quite wrapped up with debating these two but it really only matters for a few weeks at most. After that, it matters not which approach you had!
     
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  5. Going4fun

    Going4fun member

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    Great post @gloveguy. BTW, you and I are similar. I love to do medical research and get into the weeds.

    But ... there are so many variables involved in successful hip urgery ... that us lay people are likely to focus on the wrong ones. Ultimately, I knew I needed someone who had done a lot of surgeries ... got good reviews from online and various magazines and top doctors lists ... and someone I felt really comfortable with.

    It's partly that trust, I think, that lets us go forward with the surgery--not just the intellectual knowledge that our surgeon is technically skilled. And hopefully there's a daggone placebo effect with picking a doctor we trust! Again, I'm taking technical skill the basic requirement ...

    @goblue61, there are lots of skilled surgeons who elicit trust.
     
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  6. dlp

    dlp senior

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    Echoing that approach really doesn't matter. You can read good and bad about all approaches here - the major factor of recovery is definitely more related to you: your current health, your healing abilities, your attention to restrictions and instructions, etc.

    Best to go with the surgeon you feel comfortable with and let him choose the method. I did pay more attention to the implant make and model, though, because I figured I'd be dealing with that longer than any muscle issues or surgery scars :)

    Good luck!

    Oh, I'm guessing from your username you might be a Univ. of MI. fan/alum?? :)
     
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  7. Eman85

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    As others have said you choose the surgeon and they choose the approach. Trust me, the surgeons that use posterior are quite aware of all of the approaches and the pluses and minuses of them.

    The one thing is what do you or your surgeon consider a "quick" recovery? Don't have an unrealistic timeline going in. Don't think that PT or anything else is going to make the recovery faster. To be very blunt about it, they are going to disassemble you and cut off the end of your femur. Then drill it out and hammer in a metal piece. They then will ream out your pelvis and screw the socket holder in place. It really doesn't matter if they approached thru your bellybutton it's a BIG surgery. Common and quick but BIG!

    Doing it in Jan is a good choice in my way of thinking, mine was in Feb. and that's how I would prefer to do it. For me it made it easier to take it easy and recover as I like being active and outdoors in good weather. Be very realistic about length of recovery time and any thoughts of going back to work. If you do some reading here you'll find that many rushed it.

    Forgot to state that mine was posterior and it all went smoothly. My scar looks like a pink pencil line now. I didn't have any staples or stitches. I did have and followed the basic restrictions, which really isn't a big deal as your body doesn't want to do things like that post surgery. Practice doing what you will need to do and prepare your house.
     
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  8. SurreyGirl

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    I had posterior and my recovery took some time and the early days were painful. However, 5 months out all seems fine and certainly very stable.

    My OS is very experienced but also old fashioned and only does the Posterior approach. It might have been that if I had shopped around more I could have found someone who did the Anterior approach even though I am clinically obese. However this OS has a great reputation and therefore I went with him. He was a stickler about me losing weight to give me the best possible outcome and he was right. You need someone with a track record of lots of ops per year and very few revisions.

    I met an elderly lady whom he operated on 10 years ago and her scar was a long thin white line and hardly noticeable.

    I am now getting my life back - it has already made a huge difference.

    Best of luck with your op and see you in the Recovery forum in January!
     
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  9. goblue61

    goblue61 new member
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    Thank you all for the information and suggestions and already feel better about my decision to stay with the surgeon who does the posterior approach. It sounds like I am not the only one who goes overboard researching everything to the point of confusion and second guessing. Based on talking to people and online testimonials I do realize that early recovery is definitely different for every person. The one thing that is consistent though is the high percentage of satisfied people who do not regret getting the surgery and happy to "get their life back".

    Next week I have a pre-op 3 hour appointment with the hospital and PT that will give me the information needed before and after surgery. I already am making a small list of questions based on reading various post on this helpful forum.

    Again thanks all and Merry Christmas!

    BTW dlp: I grew up in Toledo Ohio and have been a die hard Wolverine fan since I was a kid. Living in Texas for over 30 years and a son attending A&M I also root for the Aggies. I think I saw somewhere you are from Michigan?
     
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  10. Eman85

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    Sounds like your OS has a good program. The pre-op class and PT info will help a lot in getting prepared. You'll need some simple things to get through recovery like grabbers,a raised toilet,comfortable chair and possibly a sock aid. You will have time to get everything and practice with them beforehand. The greatest aid in my recovery was an icing machine. Ice will be your friend and the more the better. With the machine, mine is a Breg Polar Pack, you can ice 24hrs if you want. I had very little swelling and it was gone quickly and I didn't have bruising. The hospital had me on it as soon as I got to the room and it was mine to take home. I don't see how anyone makes it without one.
     
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  11. Bionic

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    @Eman85
    It's interesting to hear your thoughts on the icing machine. I didn't have an ice machine but luckily had little swelling and no bruising either.
    Perhaps if I had a problem with either I would have been looking for a remedy but in my case it wasn't necessary.
     
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  12. dlp

    dlp senior

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    Yep - born in Detroit, and most recently lived in Ypsilanti before moving to NorCal. Drove down to Toledo a lot over the years - the wife was a fan of Dillards department store :)

    Definitely a double-satisfied patient on this end. The surgery was a life saver. Research is great, but don't work yourself up into frenzy :)
     
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  13. Wayfarer

    Wayfarer junior member

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    goblue, your situation is very much like mine. Haven't played tennis in a year, the thought of putting on a pair of skies makes me wince, and most other activity I've taken for granted for decades has just about been stopped. The family was all in Mexico for Thanksgiving; the cobbled streets of Sayulita were kicking my butt, well, hip! Part of it may have been my footwear, but I was basically hobbling around, looking for that to-kill-ya shot to numb some of the pain.

    Many days I get out of bed and am like, ok, this isn't so bad, it's going to be a good day. Some days are not so much "good," but not "too bad." It's still painful to get around. I am almost getting use to the pain being a constant; it's not debilitating, but there ALL the time and seriously limits me and what I could be doing.

    Last year I went through the Xray, PT, steroid shot things, and then finally was referred to an OS; I'm with Kaiser BTW. The first surgeon (there are three at the facility I will be) I met with only does posterior. I had mentioned that I was interested in the anterior approach as one of my tennis teammates was sold on that approach and had his done over a year and a half ago with great results. I was then referred to the first OS' colleague who does anterior only. We met last June, had a discussion, and I mentioned I wanted the surgery after the first of the new year also due to my business being a little slower (sometimes) during the first quarter.

    I'm scheduled for January 7th and had my pre-op "class" about two weeks ago. In that class were knee and hip (both posterior and anterior) patients. I had a couple/few questions as did others re hip, but some of my concerns didn't need to be addressed precisely because I was going the anterior approach. Namely, driving, sitting, toilet use, the whole 90 degree rule/thing doesn't apply to my situation going with the anterior approach. Also, any dislocation is minimized where you'd have to fall, trip, whatever backwards than more commonly forwards to dislocate; or so it was explained to me by the OS. Also, skeletal-wise I'm a good candidate for anterior; I'm tall and lanky, with wide-ish hips...although, with all the inactivity, I've developed a bit of a gut.

    I hope I get this correct as I'm paraphrasing from my pre-op class/meeting, but recovery may, may be a little quicker going anterior, but it evens out pretty quickly with posterior approach (by a few days?). Placement of that new hip is paramount and with the posterior it is...how was it explained...more straightforward coming from the posterior as far as placement? Again, with my lanky-ness, I think getting to my hip and placement should be pretty straightforward with an anterior approach. There are risks/side effects with any surgery and approach; with the anterior there is a large nerve running down the front of one's leg that can get a bit compromised i.e. numbness. My OS actually had that problem (numbness in the leg from that nerve) a bit wearing a toolbelt when swinging a hammer during med school.
     
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  14. jaydub63

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    @goblue61 Hello fellow Wolverine fan! I live in Ann Arbor and went to school there, and my daughter goes there now. She's in the marching band and got to travel to Atlanta for the Peach Bowl tomorrow.

    My surgeon does two approaches (anterior and mini-posterior) and I went in thinking I wanted anterior for all the hype about quicker recovery, etc. He actually talked up the mini-posterior to me (and does many more of them) so I went with that. I had no regrets and had a great recovery - was walking without aids in less than 3 weeks. I can't imagine that it could have been improved much by using a different approach. Like others have said, if you find a surgeon you trust, go with what he recommends.
     
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  15. SurreyGirl

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    Your OS is spot on. Exactly the way it was explained to me. I am tall and fat so posterior with all the restrictions! You are tall and lanky and a much better candidate for Anterior....

    The large nerve and anterior approach was also explained to me and the risks associated with it... That said I still have numbness in my bottom when overdoing it so wondered how that happened with the posterior approach...

    You are very wise to do all this research as you will be happy about your decision...
     
    Last edited: Dec 28, 2018
  16. Wayfarer

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    Ha, Surrey, great that I got it mostly right then; I'm waiting for that memory replacement when it comes out!

    My tennis teammate, anterior approach, who I met earlier this month with a host of others for a "hip send off" remarked that ALL hip surgeries would be and should be anterior and the only reason that they aren't ALL anterior is that there are a lot of posterior OS' out there. I didn't comment. I think each merits some costs/benefits depending on a host of variables.

    Some other anecdotes:

    My aunt, in her 80's, has had two hip replacements (she is also with Kaiser as am I). She had one posterior, one anterior...she did have one dislocation in one of the hips, but I didn't ask (cuz I didn't have the jargon/understanding when I spoke with her this past summer) of which hip it was.

    My BIL's wife (new, we went to their wedding in Brisbane this past June) is an OS (pediatric). She saw me struggling at their wedding and was like, you need your hip replaced! I was like yeah, what do you think, posterior or anterior? She said posterior of course; it's been done for ions and is a proven procedure/approach. I was a little :dubious: why that approach specifically again??? Anyway, I don't know the Aussie systems and preferred approaches, and she a pediatric OS, so that may have something to do with it.
     
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  17. SelfHelp

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    Few articles on THR I found very informative.

    For Posterior or Anterior Total Hip Replacement Surgery, Choosing the Right Orthopedic Surgeon is What Matters Most
    https://holycrossleonecenter.com/bl...anterior-approaches-to-total-hip-replacement/

    The Pros and Cons of Two Approaches to Hip Replacement: Mini-Posterior and Direct Anterior
    https://holycrossleonecenter.com/bl...placement-mini-posterior-and-direct-anterior/

    Why I No Longer Use the Anterior Approach for Primary Total Hip Replacement Surgery https://holycrossleonecenter.com/bl...proach-primary-total-hip-replacement-surgery/
     
  18. oregonlass

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    I 100% concur with the others. It’s the doctor’s skill with his technique... not the technique itself that makes the difference. if you feel good - go for it.
    I thought I wanted anterior. My doc does lateral. But it’s healing beautifully for not quite 3 weeks out.
    You are going to be so glad when January gets here and you can get this done.Yup, it’s big, but the arthritis pain is gone. Unlike arthritis pain...surgical pain is controllable. Take your time, you’re going to rock this... well maybe not this New Year’s Eve...but there a walk on cobblestone streets in your future ;)
     
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  19. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    May I remind all of you 'fact seekers' that there is any difference between these two approaches. I remember the anterior being used way back in the 1960s! It's only you young'ns that keep labeling them 'new' or 'old fashioned'!!
     
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  20. prairienut

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    Regarding the surgical approach, I have always thought it is better to let the surgeon use the approach that makes it easiest to do the job well. I am willing to put up with a different and/or longer recovery period if it means optimizing the long-term outcome. The scar from my previous RTHR is hardly noticeable. They're going in through the same scar for the revision later this week. All three surgeons I consulted said they use only the posterior approach for revisions.
     
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