What conditions exclude Anterior appr...

What conditions exclude Anterior approach?

Posted in the Hip Replacement Forum

Anonymous

Los Altos, CA

#1 Jan 14, 2011
I've been told that I need a hip replacement on my right side by my orthopedic surgeon. He does the standard lateral approach and I believe he is very competent and does lots of these and he is scheduling surgeries about 2 months in advance.

Within my HMO there is only one surgeon who does the anterior (or maybe it's anterior-literal) approach. For the anterior surgeon there is about a 2 month wait for a consultation and then a three or four month wait for surgery.

I am attracted to the anterior approach for the obvious reasons of quicker recovery and less chance of dislocation. I am trying to figure out whether I should wait for the anterior surgeon and I am wondering if I have any conditions that exclude me from the anterior approach. Here are some factors.

a) I am a 60 year old male.
b) My left leg (the good hip) is congenitally short by about 3/4". I wear lifts in my left shoes.
c) I am about 20-30 lbs overweight with the extra weight all in the abdomen.

If I wait for the consultation is there a concern that the surgeon might say that because of my short leg on the left side he does not recommend anterior approach for the right?
Michelle

Gilbert, AZ

#2 Jan 16, 2011
krausternet wrote:
I've been told that I need a hip replacement on my right side by my orthopedic surgeon. He does the standard lateral approach and I believe he is very competent and does lots of these and he is scheduling surgeries about 2 months in advance.
Within my HMO there is only one surgeon who does the anterior (or maybe it's anterior-literal) approach. For the anterior surgeon there is about a 2 month wait for a consultation and then a three or four month wait for surgery.
I am attracted to the anterior approach for the obvious reasons of quicker recovery and less chance of dislocation. I am trying to figure out whether I should wait for the anterior surgeon and I am wondering if I have any conditions that exclude me from the anterior approach. Here are some factors.
a) I am a 60 year old male.
b) My left leg (the good hip) is congenitally short by about 3/4". I wear lifts in my left shoes.
c) I am about 20-30 lbs overweight with the extra weight all in the abdomen.
If I wait for the consultation is there a concern that the surgeon might say that because of my short leg on the left side he does not recommend anterior approach for the right?
In my opinion you should wait for the doctor who does anterior approach surgery. Is it any wonder that he is busy?
I had both my hips replaced within 6 weeks of each other last year.
I am 63 and if you saw me walk and function, you will not be able to tell that I have had any surgery. I have 3.5 inches scar in the front of my leg, which does not bother me at all.
I was able to walk unattended after 2.5 weeks and drive as well at the same time. My hips were very tilted and I had limp before the surgery. Now my hips are straight and so are my legs, but my surgeon use a computer to align the hips and do the surgery.
So, go for a consultation and find out all there is to know about the surgery, you quality of life depends on it!
I am shocked that some people spend more time researching what kind of car to buy then their possible life altering surgery.
I went to 6 doctors before, I selected my surgeon.
Good luck and let us know what you will do.
Marcia Palos Park IL

Schaumburg, IL

#3 Jan 18, 2011
"krausternet,"
My legs were uneven all my life until I had anterior THR on 1 hip. Now they're the same length. You want a surgeon who does the anterior approach with the Hana table. The special table makes it easier to get both legs the same length after surgery. The table is expensive, which is why it's not ubiquitous. Please find an anterior surgeon, no matter the wait for the surgery. Your quality of life post-surgery could depend on it.
krausternet

San Francisco, CA

#4 Jan 18, 2011
The bad hip's leg is longer than the good hip's by about 2cm (0.8 inches). My understanding from the surgeon doing the standard approach is that he can make the leg on the bad hip longer, but not shorter. He says he can't make it shorter because the muscles holding everything together become too slack. He says he will always error on the side of too long rather than too short for that reason.
So I am wondering if this same issue exists in the anterior approach, or any other concerns about leg length difference when the good leg is shorter on the good.-- I imagine it's a different situation when you are having both hips done, which I am not.
Kate32

Milwaukee, WI

#5 Jan 19, 2011
Does having 2 other surgeries (not hip replacement)on my hip preclude me from having an anterior THR done? I had one already where it was an anterior incision to clean up the joint from all stuff that calcified on and around it and another surgery (2 small incisions on the side)- a laproscopic one that was supposed to help with the range of motion, but did not. Thank you all how posts answers, it is soooooo helpful!
Adriana

Atlanta, GA

#6 May 14, 2011
I did a consultation with a surgeon who does te anterior approach. Myunderstanding is that if you are too muscular tat can rule out the anterior approach.

I am going with the superior SuperPath approach which is even less invasive. There Re only 7 or 8 doctors who do it this way.
Mars

Chicago, IL

#8 Nov 10, 2011
the anterior approach for total hip replacement is rapidly growing because of its definite advantages for patients, even those in need of bilateral procedures. Rehabilitation is simplified and accelerated, dislocation risk is reduced, leg length is more accurately controlled, and the incision is small. More information at http://www.depuypinnaclelawsuit.com/
Olive

New York, NY

#9 Dec 16, 2011
Have you sought a second opinion on it? Why not try. Also, there has been a recent issue on hip replacement implant device. DePuy all-metal implant device was recalled last year. You may find information from these links helpful -> http://www.depuyhipreplacementlawsuit.com/sym... , http://1.usa.gov/sT4qDb
Ted Central New Jersey

Milford, NJ

#10 Dec 25, 2011
My right hip needed to be replaced stemming from a decades-ago automobile accident, so I made consultative visits to 2 surgeons (1 NY and 1 NJ) who routinely do the anterior approach, but neither would touch my case owing to the preious surgery at the time of that accident (both offered to do a "conventional approach").

I finally had the THR surgery done by a very prominent surgeon in a third orthopedic group here in NJ; according to the surgeon, my procedure took twice as long as typical because of the prior damage (well-over an hour), but things appear to have worked out well-enough for me - except that I'm not in "hip rules country" which one has to smile through as best as one can.
Dave

New York, NY

#11 May 13, 2012
Be careful what you look for. There is a reason that most surgeons still use a posterolateral approach for hip replacements. What the anterior surgeons don't tell you about is a recently published article that showed a 9% major complication rate (dislocation, femur fracture, infection, blood vessel or nerve injury). Anterior approach has been shown to have a faster recovery for the first 48 hours but not better recovery at any other time point. This is much more a marketing gimmick than it is a real benefit. The reason these surgeons are so busy is the huge marketing campaign behind it. Companies are pushing surgeons to use the anterior approach and then teaching them to do it with their implants and then marketing their implants. I would go with the surgeon with experience in a hospital with high volume and a great track record rather than the surgeon with the latest gimmick!
ruth mccormick

Hot Springs National Park, AR

#12 May 27, 2012
I live in Hot springs ar, been looking for a Dr who does the anterior approach hip surgery, I had a hip replacement 6 years ago on the other hip with the lateral incision, can anyone help??? It seems they also have to use the Hana Table in surgery. [email protected]
colin

Donegal, Ireland

#13 Feb 11, 2013
hi everyone,

i am only 53 and 3 years ago i could outrun an 18 yr old at tennis now both hips hurt really bad and both knees have started to hurt as well...i am very very scared..can anyone say if anterior is better than traditional for sure???...at 53 should i limp on for a few more years as hip replacements last 10 yrs and you can only have 2???...thanks everyone..please help..i am desperate...
Kaleani

Roseville, CA

#14 Jul 6, 2013
colin wrote:
hi everyone,
i am only 53 and 3 years ago i could outrun an 18 yr old at tennis now both hips hurt really bad and both knees have started to hurt as well...i am very very scared..can anyone say if anterior is better than traditional for sure???...at 53 should i limp on for a few more years as hip replacements last 10 yrs and you can only have 2???...thanks everyone..please help..i am desperate...
8 weeks ago I had the posterior approach and the first 4 weeks it was hell. The surgery itself was nothing compared to the misery of the recovery. Had to use the walker for 4 weeks and keep my operated leg off the floor 50%, all the pressure was on my left leg and knee so i started having knee pain in my good leg, the pain is still there after 8 wks. The worst was sleeping on my back with pillow between my legs for all that time, i can say i didnot sleep for 4 weeks. I was told that my other hip also needs to be done and i am deternined to do all i can this time to get the anterior surgery. I will not go thru that painful posterior recovery a second time.
Ted

Anderson, IN

#15 Jul 7, 2013
Kaleani wrote:
<quoted text>
8 weeks ago I had the posterior approach and the first 4 weeks it was hell. The surgery itself was nothing compared to the misery of the recovery. Had to use the walker for 4 weeks and keep my operated leg off the floor 50%, all the pressure was on my left leg and knee so i started having knee pain in my good leg, the pain is still there after 8 wks. The worst was sleeping on my back with pillow between my legs for all that time, i can say i didnot sleep for 4 weeks. I was told that my other hip also needs to be done and i am deternined to do all i can this time to get the anterior surgery. I will not go thru that painful posterior recovery a second time.
Sleep on a recliner (I have a La-Z-Boy) as so many here recommend after a THR and ask your doctor for a 90-day prescription for Ambien (generic is fine) and enjoy the sleep.
Joe D

United States

#17 Aug 14, 2015
Dave wrote:
Be careful what you look for. There is a reason that most surgeons still use a posterolateral approach for hip replacements. What the anterior surgeons don't tell you about is a recently published article that showed a 9% major complication rate (dislocation, femur fracture, infection, blood vessel or nerve injury). Anterior approach has been shown to have a faster recovery for the first 48 hours but not better recovery at any other time point. This is much more a marketing gimmick than it is a real benefit. The reason these surgeons are so busy is the huge marketing campaign behind it. Companies are pushing surgeons to use the anterior approach and then teaching them to do it with their implants and then marketing their implants. I would go with the surgeon with experience in a hospital with high volume and a great track record rather than the surgeon with the latest gimmick!
Hi can you advise the link for that recently published article? That statistic pretty much does not make sense, thanks!
joy

Los Angeles, CA

#18 Aug 14, 2015
I deal with HORRIFIC nerve damage from Anterior in 2010. I had a nice 5 month post op recovery going on, then it all went down hill.....Add IT band damge to that too. And 3/4" shorter leg.
CPA

Woodside, NY

#19 Jan 3, 2017
Adriana wrote:
I did a consultation with a surgeon who does te anterior approach. Myunderstanding is that if you are too muscular tat can rule out the anterior approach.

I am going with the superior SuperPath approach which is even less invasive. There Re only 7 or 8 doctors who do it this way.
I am a 68 yr old female rt a/k amputee and considering hip replacement on left hip. i had a consult with 2 docs--one w/anterior approach and one with SuperPath.My struggle is aftercare and precautions following surgery with SuperPath as i was told since it is mini posterior you have to be careful not moving leg beyond 90 degrees, no bending hip. Any ideas?

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