which method of hip replacement is the best?

Since there are both pros and cons to the anterior approach, why is it preferred by many patients and surgeons? We explain the difference between hip replacement options: a traditional posterior surgery and the … The decision to undergo a total hip replacement involves a number of considerations, including choosing the surgical approach that is best for you. As Dr. Salyapongse (and friend of PeerWell, Dr. Trevor North) explains, it may not be such a simple, clear-cut answer. Total hip replacement. In contrast, the patient criteria for anterior hip replacement may be more stringent. In addition to the anterior approach being "more accurate" and "leaving more muscles attached and unaffected", Dr. Salyapongse pointed out other benefits. He also notes that the anterior approach may not be the best option for someone who is obese or has muscular thighs, because extra soft tissue can make it harder for the surgeon to reach the hip joint. Why might I need a hip replacement? Here's what he had to say:  "If you have a good relationship with your surgeon, I would trust them to perform the procedure for you with which they have the most experience (anterior OR posterior)." Because of these benefits, the anterior approach to total hip replacement is especially appropriate if you are active and eager to return to work and daily activities as soon as possible. Traditionally, orthopedic surgeons have approached the hip joint from the side and back when doing total replacement surgery. Minimally invasive hip replacement are another option for hip replacement procedures. You must be logged in to leave a comment. Total hip replacement. Learn more about 'how to choose the right surgeon for your joint replacement surgery.'. A variation of this approach is a minimally invasive procedure in which one or two shorter incisions are used. Hip | Total Joint Replacement. Research recently presented at a meeting of orthopaedic specialists shows that patients often fare no better with minimally invasive hip replacement than those having a standard hip replacement -- and may do worse. So, what can you make of all of this? A longer procedure time means greater potential for increased blood loss (although this is low risk). A new hip replacement strategy, an anterior approach technique, allows the patient to experience less pain, have a quicker recovery, and improved mobility. Only 3% of hip replacement surgeries in the US are hip resurfacing. Salyapongse explains what he has seen first hand: "patients who have had anterior hip surgery on one side and posterior hip surgery on the other, most often prefer the anterior hip side." | A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). www.aarp.org/volunteer. Hip replacement (total hip arthroplasty) is surgery to replace a worn-out or damaged hip joint. The hip replacement operation has become a routine procedure. This surgery may be a choice after a hip fracture or for severe pain because of arthritis. to search for ways to make a difference in your community at He explains, "people who have had the anterior hip surgery have no restrictions on bending, stooping, reaching their feet, crossing their legs, or sleeping on their side after surgery." Surgeons should stop carrying out a common type of hip replacement operation on women because of … You are leaving AARP.org and going to the website of our trusted provider. We explain the difference between hip replacement options: a traditional posterior surgery and the … Of all the joints currently replaced in the human body, the hip joint has had the most success, the quickest recovery, and is the most durable. The procedure is intended to give you restored mobility and to reduce painful bone-on-bone contact. What is minimally invasive hip replacement surgery? Knowing about the different manufacturers, styles and materials will help you work with your surgeon to select the best implant for you beforehand. SANS is a great tool for anyone. Both surgeons point out that the most important determining factor actually lies in your choice surgeon. “The hip replacement is one of the most successful surgical procedures in terms of quality-of-life improvement,” he explains. Get matched to a top surgeon near you or book a free consultation with Dr. Salyapongse. AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age. Hip Implants . Hip replacement method 'unacceptable' for women. Once you confirm that subscription, you will regularly The surgeon replaces the old joint with an artificial joint (prosthesis). In our conversation with Dr. Salyapongse, we wanted to understand the difference between anterior and posterior. related to AARP volunteering. It usually begins with surgeons performing an arthroscopy, in which they reshape the hip socket to eliminate any pinching, clean up damaged cartilage and resolve other problems. According to the American Association of Orthopaedic Surgeons, more than 200,000 hip replacements are performed each year. The advantage of resurfacing is the minimal removal of material saving most of the femur. How long does a hip replacement last? The three main approaches - posterior, anterior and lateral all have their benefits and problems. But that does not mean that fractures cannot happen at all in the case of hip replacement. Traditionally, orthopedic surgeons have approached the hip joint from the side and back when doing total replacement surgery. Dr. Salyapongse explains what he has seen first hand: "patients who have had anterior hip surgery on one side and posterior hip surgery on the other, most often prefer the anterior hip side." In this surgery, worn-out or damaged sections of your hip are replaced with artificial implants. Dr. See: 10 Questions Doctors Wish Their Patients Would Ask. However, as with all surgery, it carries a degree of risk. U.S. News also ranks the best hospitals for hip replacement surgery using data on patient survival, nurse staffing, volume and more. It usually is done when all other treatment options have failed to provide adequate pain relief. An anterior hip replacement is a surgical procedure in which damaged bones in your hip joint are replaced with an artificial hip (total hip arthroplasty). If you're preparing for a hip replacement surgery, you've probably asked yourself these very questions. But now, orthopedic surgeons are employing a new, easier alternative called subchondroplasty, in which a damaged hip is strengthened by injecting a cement-like material. But now, orthopedic surgeons are employing a new, easier alternative called subchondroplasty, in which a damaged hip is strengthened by injecting a cement-like material. Another benefit that the surgeon points out is that there are fewer hip precautions after surgery. again. The cup is typically made of metal and fits into the natural hip socket. For example, some surgeons believe that the best candidates for anterior hip replacement surgery are patients who are not obese or overly muscular. He adds to this by saying, "however, there's one caveat: patients should seek out a surgeon who is well-trained and experienced with the anterior hip surgery. pros and cons of an anterior hip replacement, different types of hip replacement implants and materials, Get matched to a top surgeon near you or book a free consultation with Dr. Salyapongse. He's performed thousands of successful hip and knee replacements, making him a true topic expert. Dr. Salyapongse touches on later recovery, sharing that "some studies show that even at 6 weeks, anterior hip surgery patients are still doing better than the posterior hip patients. However, the difference between the approach is where the incision is made to access the hip. Low back issues can refer pain to the hip, and low back issues often result in poorer outcomes in Hip replacement. Over the years, each approach has had its day in the sun. A. According to Vasileff, recovering from a subchondroplasty is far less arduous than a total hip replacement, in which surgeons completely remove the damaged femoral head and the cartilage surface of the socket and replace them with artificial parts. 3  In other words, in cases of patients who've had bilateral hip replacements (whether staggered by weeks or years, or done at the same time), notable feedback is that they preferred the anterior replacement. More than 300,000 patients in the U.S. have hip-replacement surgery each year, which can require grueling rehabilitation and months of recovery before they can get back to normal. The provider’s terms, conditions and policies apply. I would say I had minimal pain, they gave me plenty of pain medication, only took about 10 pills and was totally off them by three weeks. Did you know the human head weighs 8 pounds? The more procedures the surgeon has performed, the better they will be at providing you with a great outcome." In saying this, having a replacement done by an experienced surgeon you're comfortable with is the top priority. AARP members receive exclusive member benefits & affect social change. In the meantime, please feel free Of these, osteoarthritis accounts for the majority of patients needing a hip replacement operation. The most important factor to consider is that your surgeon should be well trained and comfortable with whichever approach they will utilise. Patients who are active, in good physical shape and younger are often the best candidates for an anterior approach hip replacement. The implant procedure is the same, but the surgery may take longer because physicians work with x-rays and special instruments to guide them through the small … receive communications related to AARP volunteering. But importantly regarding pre hip replacement, the hip needs to be identified as the source of pain and dysfuncton, and any back issues need to be identified and treated before Hip replacement. You will be asked to register or log in. This type of surgery is just as safe and effective as traditional hip surgery, but with quicker recovery times. The Lancet. Anterior or posterior? Dr. Salyapongse adds, "recent studies have shown that early recovery (the first 6-8 weeks) after anterior approach surgery seem to be faster and less painful.". Most surgeons use the posterior approach for hip replacement surgery. Traditional hip replacement is available to any patient healthy enough to undergo surgery. Looking to have a hip or knee replacement surgery? See: 10 Questions Doctors Wish Their Patients Would Ask. This means that the surgeon can perform the surgery working between muscles without detaching or cutting them." The results for all of these approaches have been shown to be very similar. How to Determine Which Hip Replacement Surgery Method is Best for You. The posterior approach to total hip replacement is the most commonly used method and allows the surgeon excellent visibility of the joint, more precise placement of implants and is minimally invasive. The hip joint can be damaged by osteoarthritis, other forms of arthritis, and other traumatic or degenerative conditions. So, which hip replacement approach should you request from your orthopedic surgeon? Mayo Clinic in Rochester, Minn., and Mayo Clinic in Phoenix/Scottsdale, Ariz., are ranked among the Best Hospitals for orthopedics by U.S. News & World Report. Comments: 0. You'll start receiving the latest news, benefits, events, and programs related to AARP's mission to empower people to choose how they live as they age. The other is the lateral approach. The goal of using shorter incisions is to reduce pain and speed recovery. The physicians at the Cedars-Sinai Orthopaedics are consistently striving to develop new technologies, instrumentation and techniques for hip replacement surgery. Various types of arthritis may affect the hip joint: Osteoarthritis. Metal-on-metal hip resurfacing is done in a similar way, however this is rarely done now because of possible complications and a higher "failure rate". Especially when it comes to a surgery like hip replacement. In other words, Dr. Salyapongse believes that the anterior approach is superior to posterior (hehe, we rhymed!). In many cases, well-trained surgeons using special instruments can shorten the incision of a standard hip replacement to about 4 inches. More than 300,000 patients in the U.S. have hip-replacement surgery each year, which can require grueling rehabilitation and months of recovery before they can get back to normal. The difference with the anterior hip replacement procedure from the traditional method is the technique used to reach the hip joint. The reason being, Dr. Salyapongse shares it that "they report faster recovery, easier rehabilitation, and less pain". In other words, in cases of patients who've had bilateral hip replacements (whether staggered by weeks or years, or done at the same time), notable feedback is that they preferred the anterior replacement. Eligibility for the Anterior Approach to Total Hip Replacement Surgery. An anterior hip replacement performs the same purpose as a traditional hip replacement. To replicate the action of your natural joint, a total hip replacement has 4 parts: a socket (cup), liner, ball (head) and stem. Read on as we try to help you answer this tough question. I cover all topics for your hip & knee replacement needs. You can also manage your communication preferences by updating your account at anytime. The Anterior hip approach has a higher complication rate in inexperienced users and there is no data showing better long term outcomes. One is called the posterior approach, in which the surgeon makes an incision, or cut, through muscles on the back of the hip. The new procedure injects a cement-like material into the damaged hip which solidifies within minutes. But now, orthopedic surgeons are employing a new, easier alternative called subchondroplasty, in which a damaged hip is strengthened by injecting a cement-like material. U.S. News also ranks the best hospitals for hip replacement surgery using data on patient survival, nurse staffing, volume and more. Without a doubt this can make for an easier "return to normal"  and underscores a possible jumpstart on recovery. Take this quiz to test your smarts and prepare for a successful surgery. Learn more. Hi, I'm Grace. by Patrick Kiger, AARP, January 18, 2018 Read on for this and other useful info like how to prehab for hip and knee replacements. The SUPERPATH™ hip replacement is a new technique using superior capsulotomy that allows for implantation of the total hip components under direct vision through a single incision. An example of such an incision is illustrated in Figure 1. Dr. Gross’ registry shows devices implanted 14-15 years still performing as expected and outperforming total hip survival. Total hip replacement (also known as hip arthroplasty) is a common orthopaedic procedure and, as the population ages, it is expected to become even more common. Before delving deeper into the risks, it’s worthwhile reviewing the two other types of hip replacement surgery commonly performed in Canada. Which approach is better? Surgeons who typically perform at least 100 hip replacement procedures per year are in the best position to adopt shorter incisions, while keeping the procedure the same. A. There are two commonly used surgical approaches for the implant, but which one is best for you? He adds that "not all patients experience this, but when they do, it can last for a year or so.". The traditional surgical approach to total hip replacement uses a single, long incision to view and access the hip joint. The pieces may be made of metal, plastic, ceramic, or a combination of these materials. As such, trust in your preferred surgeon is the top priority. The femoral head is ball-shaped and fits into a cup-shaped compartment in the pelvis. During hip replacement surgery, the damaged bone and cartilage are removed from the hip joint. Replacing the hip joint with an implant or "prosthesis" relieves pain and improves mobility so that you … This can be caused by osteoarthritis or a previous injury to the hip. Greater potential for post-op numbness in the upper thigh. If a thigh-bone fracture occurs during hip resurfacing, the surgeons have no option but to continue with the total hip replacement procedure. This approach is often considered the  "latest and greatest" in hip replacement surgery. Longer procedure (this increases risks associated with surgery, like "blood loss".). However, the most critical factor to the success of an anterior hip replacement is having a surgeon who you're comfortable with, has performed a high-volume of anterior replacements, and matches your individual needs. Dr. Salyapongse adds that the anterior approach can sometimes be "more accurate" because x-ray guidance and technology is used during the procedure. A return to full activity, including playing sports, can take six to nine months, he said. Less common with fewer "expert" surgeons who specialize in the approach. W. Kelton Vasileff, an orthopedic surgeon at the Ohio State University Wexner Medical Center, says the procedure originally was developed to treat ailing knees. However, this is not the case with hip replacement. 2019; doi:10.1016S0140-6736(18)31665-9. If you think that you might be a good candidate for a robotic-assisted total hip replacement, you should talk to your doctor. The liner is most commonly made of a medical grade plastic called polyethylene. Please enable Javascript in your browser and try Nowadays, another common technique known as a minimally invasive method is used by surgeons, in which 1 or 2 cuts are given, 2 to 5 inches long. When it comes to total hip replacements (THR), there is a lot of debate about the relative risks and benefits between two popular surgical techniques – the anterior approach versus the posterior approach. Less invasive, leaving more muscles and tissues in tact, Closer to a "normal gait" in the first six weeks after surgery. This surgery may be a choice after a hip fracture or for severe pain because of arthritis. Anterior hip replacement is a common type of total hip replacement. Dr. Salyapongse is a popular orthopedist who operates out of Dublin, California and Pleasanton, California. But as time goes on, anterior and posterior hip replacement patients both do very well.". Hip replacement surgery has come a long way in the past couple of decades, with faster recovery times and lower risk of complications. The hip joint is where the head of the thigh bone or femur meets the pelvis. ER trips often point to larger health problems for older patients, Keep Sharp: Build a Better Brain at Any Age Book. Are you in the California-area? Learn about the different types of hip replacement implants and materials. Advocates say it’s easier, less invasive, and has a … While there are many ways to access the hip joint to perform a total hip replacement, this method is one of the safest and most efficient ways to preserve and protect all the important structures around the hip joint and to facilitate both early recovery and long-term function. You will be given a general anaesthetic, which makes you fully unconscious, or a spinal anaesthetic, which numbs the lower half of your body. What is hip replacement? Hip replacement surgery is a procedure in which a surgeon makes an incision over the side of the thigh, removes the diseased parts of the hip joint, and replaces them with new, artificial parts. A great, high-volume surgeon is the "trump card" over approach. The anterior approach hip replacement is a muscle-splitting approach, meaning that the surgeon gets to the hip between two muscles, rather than by removing and then reattaching a muscle. The size and placement of the incisions will be different. WW will help you build a customized weight loss plan. Another con that Dr. Salyapongse points out is  "the occasional sense of numbness over the side of the thigh after surgery." As a result of not cutting muscles, less of the patient's natural anatomy is tampered with. This approach is considered the "traditional", "tried and true" method. You'll find lots of different answers, and each person thinks they've got the right one. Hip replacement (total hip arthroplasty) is surgery to replace a worn-out or damaged hip joint. Vasileff says he has used the procedure to repair the hips of patients from their 20s to 50s, but he thinks it also would work on older patients as long as they don’t already have a lot of arthritis. It … Hip replacement surgery usually takes 2 to 3 hours. Free chapter from AARP’s book by Dr. Sanjay Gupta. This post is part of the Ultimate Guide to Total Hip Replacement. The socket is replaced with a durable plastic cup, which may or may not also include a titanium metal shell. After this, standard hip replacement surgery is performed. One is called the posterior approach, in which the surgeon makes an incision, or cut, through muscles on the back of the hip. It replaces your hip joint with an artificial one. Total hip replacement surgery involves removing the diseased portion of the hip joint and replacing it with an artificial hip, called a prosthesis. ", Before we end our interview with orthopedic extraordinaire, Dr. Salyapongse, he adds that "after a year or so, all patients typically have the potential to be doing equally as well regardless of approach.". Orthopedic surgeon, Dr. Trevor North echoes a similar perspective, saying "the most important thing when deciding your joint replacement approach is the relationship you have with your surgeon". “Usually, you’re up walking quickly and pretty normally within a month, without crutches or a walker,” he said of the new procedure. Traditional hip replacement During a traditional hip replacement, an incision is made on the side of the hip. There's more to a hip replacement surgery than meets the eye. The anterior approach can also take longer to perform as it is slightly more complicated. The advantage is thought to be that rehabilitation can proceed more quickly by not having to allow the reattached muscle to heal. Recently, however, using the anterior approach has re-emerged as a viable option for certain patients, because it can also be done through smaller incisions using more specialized instruments. Other reasons for hip replacement include injury, infection, and brittle bones. Its not !The best method is one hat allows the surgeon to accurately implant the best prosthesis in the correct position. The other is the lateral approach. Patients should consult with a physician to discuss the various types of hip replacement procedures if pain and stiffness start to interfere with life. You may remember me from such titles as: "Diabetes & Joint Replacement 101" & "Sex After a Joint Replacement". There is no 'best' method for performing a hip replacement. In short, both approaches result in a hip replacement. In other words, in the same way that the anterior approach is popular today, the other approaches have been abuzz with surgeons and patients at one time or another. I just recently, three months ago had a total hip replacement by the anterior method, My surgery was at 7:30 and I was home by lunchtime, I walked out of the “hospital” actually outpatient facility with my walker. Should I have an anterior or posterior hip replacement surgery? In addition, not having as many restrictive "hip precautions" after surgery is a massive bonus for many patients. The incision used in this posterolateral approach, as it is called, is about six to nine inches long and is made along the side of the hip and the upper thigh. A hip replacement is also known as hip arthroplasty or a total hip replacement. Since each implant is very di… In saying this, Dr. Salyapongse adds that "if you have the means and time to seek out an experienced anterior hip surgeon (e.g. In a posterior approach, the incision is made through the back of the hip while you're on your side. The hip joint is exposed and the damaged part is removed and replaced with the prosthesis. Anterior hip replacement accounts for only 15 to 20 percent of THR surgeries in the U.S. Anterior hip surgeries are relatively new, and although they provide excellent outcomes, most surgeons still use the traditional posterior method. Ultimately, the hip replacement implant you end up with is selected by your surgeon depending on fit, your arthritic damage, activity level, weight, age, and other lifestyle factors. These parts mimic the way a normal hip joint works. Different Hip Replacement Approaches. The procedure should relieve a painful hip joint, making walking easier. Asking orthopedic surgeons what hip replacement is best is like going to a car show and asking people which car is best. Anterolateral (Watson-Jones). Dr. Salyapongse explains, "Although the basic concepts of hip replacement surgery remain the same with both the posterior and anterior approach surgery, there are some key differences." This artificial joint (prosthesis) helps reduce pain and improve function. Your total joint specialist will custom fit your prosthesis for your body type. A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. To replicate the action of your natural joint, a total hip replacement has 4 parts: a socket (cup), liner, ball (head) and stem. New Procedure May Replace Traditional Hip Replacement Surgery Subchondroplasty involves an injection of bone substitute. Is one really preferred? In the next 24 hours, you will receive an email to confirm your subscription to receive emails We love telling people about what we're doing! Is one approach really better than the other? Eventually, after a couple of years, the patient’s body will replace the material by growing new bone, he says. Best Hospitals for Hip Replacement Hip replacement surgery is usually recommended when a person has extreme inflammation and arthritis in the hip joint, making it painful to do daily activities. Hip pain caused by this damage can be treated in several ways. Says Dr. Grady-Benson: “Understand that both approaches can yield excellent and equivalent results as reported by patients six months later. The patient is typically lying on his or her side, and the hip is approached on the side and then around the front (anterior) portion of the hip. It is also called total hip arthroplasty. Please return to AARP.org to learn more about other benefits. Read on as we explain what the anterior approach is, how it differs from posterior, and share the pros and cons of an anterior hip replacement. If your hip pain is not responding to non-surgical treatment methods such as physical therapy and medication, your doctor may recommend total hip replacement surgery. This means that some surgeons are not as well-versed in the anterior approach. Become part of the PeerWell community on social media. Anterior hip replacement is done with the patient lying on their back on a special table that allows precise positioning of the affected leg. Subchondroplasty also eliminates the risk of implants wearing out, requiring additional surgery, a problem that younger and physically active hip-replacement patients can face. In saying this, like most things in life, the more you know, the better you can do. During hip replacement, a surgeon removes the damaged sections of your hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic.

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