Tag Archive: hip replacement

Anterior versus Posterior Total Hip Replacement

The surgical approach to total hip replacement (THR) may impact the surgical outcome. Total hip replacement is a common surgery, with more than 300,000 procedures performed in the United States each year. Traditionally, most total hip replacements have been done using the Hip painposterior approach, in which the surgeon accesses the hip joint through the buttocks or side. More recently, surgeons are using the anterior approach, which involves entering the hip joint through the front thigh region.

According to researchers, both direct anterior and posterior surgical approaches for THR yield excellent results as reported by patients. The surgical approach is not the singular variable that makes a difference in a 6-month post-operative outcome. Patients considering total hip replacement should ask the orthopedic surgeon about which approach is best for them. A decision will be made based on the risks and benefits of the surgical approach for the individual patient.

Clinical Studies

In a recent clinical study, involving 275 patients who had a total hip replacement between 2012 and 2014, the average age of patients was 65 years. Using certain outcomes for evaluation, researchers compared the two groups regarding pre- and post-surgical pain, function in recreation, function in daily living, and hip-related quality of life. According to results, there were no significant differences between the two groups.

In another study, researchers compared radiographic, clinical, and surgical outcomes among patients undergoing total hip arthroplasty performed via the posterior versus anterior approach. After evaluating 17 studies and 2,300 patients, researchers found that there was a significant difference in favor of the anterior approach regarding dislocations and length of stay after surgery.

canstockphoto38482995Researchers have found that the extent of muscle damage is different for each surgical approach as well. In a randomized clinical trial, researchers compared the two procedures. The main end point was the ability to walk unlimited distances and climb stairs at 6 weeks, 3 months, 6 months, and one year post-operative. At the 6-week follow-up, the direct anterior group had more patients walking limitlessly and climbing stairs compared to the direct posterior group. The differences were not as significant later on in the recovery process. However, the direct anterior approach was found to provide earlier restoration of function after total hip arthroplasty.

Another group of researchers evaluated 88 procedures (41 anterior and 47 posterior approaches for THA). The length of stay after surgery was shorter for the anterior group than the posterior group. The duration of surgery was longer, however, for the anterior approach group. Both groups performed similarly on questionnaires regarding pain and clinical outcome measures at the 6-month follow-up.

Before your surgery, the orthopedic surgeon will complete an extensive evaluation including a past medical history, physical examination, hip x-rays, and certain blood and diagnostic tests to establish fitness for surgery. Careful consideration will be given to how much pain the patient has and how often pain limits bending, walking, and resting. In addition, the surgeon will evaluate what measures have helped alleviate hip symptoms in the past.

How the Procedures Vary

During both anterior and posterior THR procedures, the head of the femur must be removed and replaced with a metal stem, as well as a ceramic or metal ball. The damaged cartilage and bone are removed from the hip socket and replaced with a metal prosthesis. Finally, a plastic spacer is placed between the new socket and ball to allow for a smooth gliding motion.

With the posterior approach, the hospital stay is usually 2-8 days, depending on the patient’s health condition, the severity of hip damage, and the surgeon’s recommendations. The incision will be 10-12 inches long, running from the outer buttock. Some muscles around the hip joint are cut and repaired, and recovery is 2-4 months. People who have this procedure have to follow specific precautions for 6-12 weeks, which include no internal rotation (turning leg inward), no crossing the leg, and no bending past 90 degrees.

With the anterior approach, the hospital stay is shorter (2-4 days), and the surgical incision is along the front aspect of the hip. The incision is shorter with this procedure (4-5 inches), and recover time is only 2-8 weeks. There are no specific precautions with the anterior approach, which makes it a more desirable procedure. With both procedures, patients must use an assistive device (walker or cane) while moving about, and physical therapy is required to improve strength, range of motion, and mobility.

Orthopedic and Sports Performance Institute in Gilbert AZ offers top hip replacement with surgeons performing both anterior and posterior procedures. Most insurance is accepted, with some of the procedures offered as an outpatient or a one day stay. Call us now!

Resources

Barrett WP, Turner S, Leopold J (2013). Prospective randomized study of direct anterior vs posterolateral approach for total hip arthroplasty. J Arthroplasty, 28:1634–8.

Higgins BT, Barlow DR, Heagerty NE, & Lin TJ (2015). Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty, 30(3), 419-434.

Martin CT, Pugely A, Gao Y, et al. (2013). A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty, 28:849–54.

 

Hip Replacement Surgery in Gilbert and Chandler AZ

Hip replacement surgery, also called total hip arthroplasty (THA) is a procedure reserved for Hip painpatients who have severe hip joint damage or degeneration. The disability and pain from arthritis can impair your ability to perform daily activities and influence your quality of life.

How long does total hip replacement last?

In general, a total hip replacement lasts over 20 years. However, it is best to consider failure rates. If you have a total hip replacement, you have a 90-95% chance that the joint will hold up for 10 years, and an 80-85% chance that it will last for 20 years. As technology improves, these numbers will go up.

Are all joint implants the same?

The majority of joint implants are similar, with the AZ orthopedic surgeon using the design that works best, lasts longest, and has the fewest complications. However, the variable to consider is the bearing surface, which is the ball and liner that attaches to the stem and the cup that adheres to the bone. Balls may be composed of ceramic or metal, and the liner can be made of metal, plastic, or ceramic.

Which approach is best?

The surgeon may perform one of the following approaches:

  • Posterior approach – This is the most common approach, and it involves surgery done from Hip-Replacement-Anterior-Approach-Incisionthe posterior (back) region of the hip.
  • Mini posterior approach – Done from the back of the hip with smaller incisions and less tissue trauma.
  • Anterior approach – Performed from the front aspect of the hip.
  • Lateral approach – Less common approach done from the side of the hip.

The Board Certified Gilbert orthopedic doctors at OSPI offer the anterior approach in a minimally invasive fashion. This reduces postoperative complications and speeds up rehab.

What type of anesthesia will I be given?

Hip replacement surgery can be performed using both general and regional anesthesia. With general anesthesia, the patient is put to sleep. With regional anesthesia (spinal, epidural, or nerve block), only a portion of the body is paralyzed. This type of anesthesia reduces complications and improves recovery time.

Is this a minimally invasive surgery?

Arthroscopic hip surgery is a minimally invasive procedure, which means smaller incisions and less tissue disruption below the incision. Less muscle cutting is involved with a minimally invasive procedure, as is less tendon detachment from the bone.

How big is the incision be and will it leave a scar?

The size of the incision depends on many factors, such as the patient’s weight and height, the surgeon’s requirements, and the complexity of the procedure. Smaller incisions mean less canstockphoto24680715(1)scarring. The scar will heal after a few weeks, and then change in appearance over time. However, most patients have a small scar for the remainder of their lives.

How long do I have to stay at the hospital?

Because hip replacement surgery involves anesthesia and immediate rehabilitation, you will stay at the hospital overnight, and possibly, for an additional 1-3 days. This depends on your rehabilitation protocol, how fast you progress, your age, your medical conditions, and the surgeon’s preference.

How soon before I can walk?

After a total hip replacement, most surgeons recommend that you get up and start moving immediately. Most people can walk with a walker the day following the procedure and with a cane in 2-3 weeks. Most people who undergo THA are able to fully participate in daily activities after 6 weeks. By the third month, many patients have regained strength and endurance and can fully participate in usual activities.

What can I expect with physical therapy?

You will receive physical therapy during your hospital stay, and for 1-4 weeks after you go home. Much of the therapy involves general stretching and muscle strengthening exercises, as well as learning to use assistive devices, such as the walker, cane, and hand held devices. The therapist works with you to return to work activities, but if you have a physically demanding job, you may have to wait 2-3 months. For physical therapy treatment contact our expect

What restrictions follow the surgery?

Depending your individual case (condition, type of surgery, extent of repair, etc.), you may have certain rehabilitation restrictions. Most surgeons give you instructions on which positions of the hip increase your risk for dislocation, and these positions should be avoided. After 6 weeks, the restrictions are lifted. In addition, you must avoid high-impact activities, such as long distance running, skiing, and basketball.

Joint Replacement with Top Gilbert Orthopedic Surgeons

Joint replacement is a significant procedure for the hip, knee, shoulder, which is often reserved as a last resort option. Joint replacement can be performed for several joints in your body, with the most common by far being the knee or the hip.

Total hip or shoulder replacement is a surgical procedure where the normal ball and socket joint in that area is replaced with a plastic cup and a metal ball, both of which are meant to simulate the natural joint in your body. These procedures are intended to restore natural function in that joint and provide you the opportunity to continue living independently.

Who qualifies for total joint replacement surgery?

Someone who is suffered from severe tendon damage, joint damage, or severe cartilage damage should exercise all nonsurgical treatments available. Once all nonsurgical treatment options have been tried and the results do not rectify the pain leaving you with severe pain and inability to move your joint properly, total joint replacement surgery might be the last option. This surgery should only be utilized if you have permanent damage to the joint which you cannot be fixed in any other fashion and nonoperative treatments have failed.

What happens after the replacement?

After the surgical replacement of your hip or knee joint you will be monitored overnight. Certain patients at OSPI are able to receive an outpatient hip or knee replacement. For those who don’t qualify, inpatient stay make take 2-3 days.

Given the severity of this surgery you might have to work with a professional and licensed physical therapist for the first few weeks after your surgery.You will also need somebody to be with you during the first few weeks of your recovery. After the first two weeks of your recovery you should be able to dress yourself and feed yourself but it is nonetheless recommended that somebody remain with you. Following the surgery and recovery you will be asked to return to either your Gilbert or Chandler orthopedic surgeon’s office or the hospital to have x-rays and a follow-up examination. Both of these are designed to see how well the surgical process took and how well your body is responding.

Are there complications?

This is a very technical procedure but like all surgeries it does come with potential complications including the risk for bleeding and infection. There is a potential for stiffness, blood clotting, and other issues.

What can be expected during recovery?

Following your surgery you will have to wait in a recovery room for at least two hours prior to being placed in your hospital room. You will be monitored during this time for your responsiveness and you will be administered pain medication if you need it. After the first few days he will need somebody to drive you home and stay with you overnight.

OSPI is the top orthopedic surgery practice in the East Valley of AZ serving Gilbert, Chandler, Mesa, Queen Creek, San Tan, Casa Grande and surrounding areas. Most insurance is accepted, call OSPI today at 480-899-4333!

JOIN OUR E-MAIL LIST!