Restrictions after Minimally invasive THR by Anterior Approach

Bones, joints and muscles
1

I am still undecided and scared. Following lots of research I am given to understand that recovery after THR by the Anterior Approach is less restrictive,ie the 90 degree rule does not apply and risk of dislocation is lower.

Please does anyone have experience of the Anterior Approach,and can you offer any comments ?

I am terrified not only of the op. but of undoing the good work by my clumsy and awkward  movements afterwards. Living alone and being old (79 years), and accident prone, I am keen to make the most sensible choices.

I have been following the forum for ages and have learned a great deal from the many hippy contributors. Thank you all for your open and generous contributions and many thanks for any answers to this post.

Love and warm regards to all of you

Joy x

2

Gloria, I to wanted the anterior approach for the same reasons you listed. My Dr. Talked me into a lateral approach mainly because of my height. I'm only 5'2 and have short thighs. He said he would do the anterior if I insisted, but he would have more room to work if he did a lateral. Which is down the side of your thigh. Basically it's the same as anterior, no restrictions, no rules to follow. I have had no problems. So talk with your surgeon because everyone is different. You can watch the procedure on you tube. If you are inclined to watch that kinda thing. I found it fasinating!!

3

I have just scheduled a THR and have decided on Posterior approach after a long conversation with my brother who is an orthopedic surgeon and my own surgeon. I also read an article in the Journal of Bone and Joint Surgery. Despite great claims to the contrary, the study the journal cited (sample size 100 pts) showed longer surgical time (resulting in increased blood loss and time under anesthesia) and higher pain afterward with anterior. My brother said there is also an x-ray machine in the OR with anterior and a tech along with that which in his opinion increased infection risk. He also told me it is not a "new" approach but was called something else 45 years ago. (He is 60 and has been practicing 35 years.) The heavy marketing in the states may be to cover the cost of the operating tables for anterior because they are over $100,000.

Having said all this and feeling solid in my own choice, I have two friends who had hips done with anterior approach and they seem to be flourishing and very pleased with the results. Choose your surgeon carefully and go with what seems to make sense to you after doing your research. Best wishes.

4

I am relieved to see your comments as some of what you are saying echoes my 'research'. I had a posterior replacement as a 'youngster', (about 52,) 12 years ago and the outcome was really pleasing although as we know the restrictions for the first 6 weeks are frustrating.

I have been languishing with the other hip needing to be done. An operation delayed 12 months through under insurance. Having moved cities (in Australia) I needed to find a new surgeon and the person recommended comes with very high credentials. However he (aged mid 50s) does posterior ONLY and has been very strong in his criticism of the anterior which I would prefer because of the seemingly less restrictive post-operative period.

Like Gail I also have an older former orthopaedic surgeon brother who has recommended posterior (as has my young GP and my older GP brother) but I do wonder whether the reason these older men prefer the traditional approach is in part because that it what they were trained in?

On the other hand, I have read copiously on both side of the debate and my lingering doubts re anterior include:

. is the approach ultimately as durable as the posterior outcome?

. does a shorter stem potentially shorten the prosthesis fit?

. the risks of femoral nerve damage?

I would really appreciate any comments and thoughts from others about these issues thanks.

Ynlike Gail i am still in the wilderness decision making period and am going to see a local anterior person this coming week to add to my confusion.

Thanks in anticipation Eliz

5

Hi Gloria!

I am 56 and had the lateral approach 7 months ago. I had no restrictions although I took it easy for a month or so. I still have a slight limp which seems to develop after walking for any length of time. I still have some pain from the surgery but nothing like the bone on bone pain I had with my OA. I need to have the other hip done as well and will most definitely have the lateral approach again.

It wasn't as bad as I had expected.

Good luck to you!

6

I had a posterior approach due to a previous knee replacement. The restrictions just required extra planning but weren't really a problem. It would be very difficult to dislocate the hip as it hurts whenever you go close to 90 degrees. Ultimately you may not have a choice because some people aren't suitable for the anterior approach.

7

Thanks. Hadn't seen this comment saying you had posterior when I responded to your private message.

I am interested in why, or why not, peoples' choice re posterior versus anterior particularly re longevity and nerve damage risk.

8

Hi Eliz what state do you reside in. I am from Sydney my name is Mark I had the new method of surgery and can't talk highly enough about it. My surgeon was Dr Sol Qurashi and he pioneered the method here in Sydney about 4 or so years ago. I won't go into all the details except to say I have had no problems whatsoever and it is coming up to 12 mths.

If you research him you will hopefully resolve a lot of your issues.

All the best

Mark

9

Hi Gloria, 

I didn't know about the different approaches to THR surgery and had posterior 

in March 2015 on right hip - Unfortunately left hip needed to be replaced and when I asked about anterior my surgein told me he preferred the posterior approach for me ... 

have you discussed this with your surgeon? 

good luck and let us know what decision you'll make -

welcome to our hippies family - the most supportive, funniest and \loving friend you can have -

big warm hug

renee

 

10

Hi Gloria

Many surgeons prefer posterior because they can see better and get a better fit. The restrictions are for 6 weeks ans should not be the key decider as you can plan ahead for those - i have had 2 posterior thrs. So putting aside the restrictions its about you having the best surgery outcome in the longer term - that is my advice on what to focus on. Many hippoes have different health issues as well as hip problems, we are different ages and heights and weights.

So you will get a wide range of advice from such a widely experienced group and its not possibly to average out the response to get a good avearge answer.

Perhaps ask the surgeon "if i was your mum - what would you advise for me -to give me the best long term outcome and lowest surgical risk?" Asked these questions surgeons cant help be flipped into giving a considered response.

Good luck with whatever path you take and once taken - dont over think the decision or worry about it. Promise? I know what overthinking does to my peace of mind ;-)

Chris

11

hi chris ....

good question - it reminds me of my mechanic (in L.A.) whom I asked the same question regarding a big repair on my car - except I asked him: would you have your wife drive my car ?   he responded : My wife yes, my mother no ....

(sorry )

12

Renee

v funny!

the CT scan operator at our hospital reckoned it was so dodgy the only person he would allow in it was his mother in law! This was told me by a consultant as we booked me a scan elsewhere. CT machine since been replaced

13

Dear Gloria,  I can't answer your questions about Anterior hip op but Ican try to reassure you about being on your own at home.  I had a full hip replacement 9 weeks ago..( can't believe that) and was so nervouse which was when I saw this site..You will manage but would be good if you could have smoneone wih you first few days.  The hospital won't discharge you until you are able to go to the loo and climb steps on your own.  I was kept in 6 days. I do not have children and am widowed and it is harder no doubt..even when folk say 'My husband/wife is out all day' the impliaction being that they are alone..but not so as whatever catastrophe has happened during the day ( dropped and spilt things) they will deal when they do come home and the nights there is someone there to re assure....however you may be offered help?  Where are you?  I wasn't and am only a little younger than you..As on many replies take all the help that is offered.  Stay on this site for help and support.  What is the difference between the two ops?

Big Smiles

ALi 2

14

I had anterior approach in May, it was the surgeons choice not mine. With that surgery muscle and ligaments are stretched, no cutting of muscle. No hip pain as soon as I woke up.The hospital has the Hanna Table and that makes it easier for the Dr to manipulate the leg.

Mine was also uncemented, and incision was glued shut. I used a wheeled walker for about a week then a cane for about 3 weeks. Had PT at home and outpatient. I'm fine, only have a bit of a problem kneeling to the floor.

15

I am the same age as you and had my second

THR 5 weeks ago. I had the lateral incision, uncemented,

both times. I had GA for the first op and spinal and was

awake for the second.I could see the clock and the actual

surgery time was 1 hr and three quarters.

 Independence is one thing, but taking all support available

is paramount. Have you been offered alternatives? Most surgeons

have their set preferences, only adapted to the patient's age and

medical history.

You are right to be fearful, we all were, but we had the op because

we had to, and we came out the other side glad we'd had it.

Regarding our age, it will surprise and please you to hear that

we oldies do well.. We don't rush our recovery, we are realistic

about the results, we do as we are told, and,as children who grew

up in wartime, it is appropriate to say on Remembrance Day,

we just get on with it.

ask me whatever,

love Cathie

16

My brother is trained in Anterior as well as posterior but is not a quick one to jump on the band wagon as he monitors long-range outcomes.He has stayed up with the literature and when the excitement settles down, at 8 wks post op, both outcomes seem identical. Durability with anterior is an unanswered question although there is no reason to suspect problems, the data is just not there yet.  He did speak about greater risk to nerves but in honesty, it didn't register too much. I was feeling pretty overwhelmed at that point. There are some "older" surgeons in my city doing anterior. I had an appt with one but after looking at the current lit, settled on posterior. It is so hard taking responsibility for all this. Wearying to deal with it on top of the pain. Good luck to you.

17

Many thanks mark

I had first hip done years ago in Syd but now in Adelaide. Am booked for posterior in 6 weeks but also going to see a young bloke whi is doing anterior on Wednesday.

18

Thanks Gail. Your situation sounds remarkably similar to mine in terms of agonising over the approach. I recall the limitations after my first hip and would obviously love to avoid or dominish them this time but as you say the data just isn't there yet about the long term durability of the anterior outcome. On the other hand i ask myself why surgeons who have been highly reputed for their work (such as my former bloke in Sydney) would have switched to another method (he is now 70% anterior) unless they had long term faith in it as they would not want to be associated with something that was suspect. 

19

Hi Aussie Liz

i thunk you revealed the dilemma with the use of the word faith - its faith in advance of statistics. Lots of well meaning experienced surgeons used resurfacing for women as a safer less invasive solution and this has had disastrous consequences for so many that its use has shrunk in recent years. Feeling better 3 weeks sooner is nothing really -against a record of traditional hips that have shown to last 20& years. We have to play the long ball game on this procedure. In 50 years time this whole approach to hips will appear to be barbaric, hopefully - too late for us lot of crocks

cheers

chris

20

That is such a good way of putting it, thank you.