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    which method of hip replacement is the best?

    Traditionally, orthopedic surgeons have approached the hip joint from the side and back when doing total replacement surgery. 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)." The femoral head is ball-shaped and fits into a cup-shaped compartment in the pelvis. Adults of any age can be considered for a hip replacement, although most are done on people between the ages of 60 and 80. … W. Kelton Vasileff, an orthopedic surgeon at the Ohio State University Wexner Medical Center, says the procedure originally was developed to treat ailing knees. The three main approaches - posterior, anterior and lateral all have their benefits and problems. 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. Please enable Javascript in your browser and try Especially when it comes to a surgery like hip replacement. A. A modern artificial hip joint is designed to last for at least 15 years. Eventually, after a couple of years, the patient’s body will replace the material by growing new bone, he says. Why might I need a hip replacement? The hip joint is where the head of the thigh bone or femur meets the pelvis. 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 the meantime, please feel free 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. Is one really preferred? However, this is not the case with hip replacement. Different Hip Replacement Approaches. 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. Longer procedure (this increases risks associated with surgery, like "blood loss".). Find out about the risks of hip replacement surgery. 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. However, as with all surgery, it carries a degree of risk. The procedure is intended to give you restored mobility and to reduce painful bone-on-bone contact. 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). Anterolateral (Watson-Jones). The other is the lateral approach. To get to the bottom of the "anterior vs. posterior" debate, we spoke with top orthopedic surgeon, Dr. Aaron K. Salyapongse. receive communications related to AARP volunteering. There are two commonly used surgical approaches for the implant, but which one is best for you? Hip replacement (total hip arthroplasty) is surgery to replace a worn-out or damaged hip joint. AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age. 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. Less common with fewer "expert" surgeons who specialize in the approach. A return to full activity, including playing sports, can take six to nine months, he said. 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. In saying this, having a replacement done by an experienced surgeon you're comfortable with is the top priority. This type of surgery is suitable for almost all patients. Hip replacement method 'unacceptable' for women. This post is part of the Ultimate Guide to Total Hip Replacement. In this surgery, worn-out or damaged sections of your hip are replaced with artificial implants. Most surgeons use the posterior approach for hip replacement surgery. The most common type of hip replacement surgery is called a total hip replacement (also called total hip arthroplasty). He elaborates, "the anterior approach involves a true internervous/ intermuscular plane. Over the years, each approach has had its day in the sun. Another con that Dr. Salyapongse points out is  "the occasional sense of numbness over the side of the thigh after surgery." ", 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.". ER trips often point to larger health problems for older patients, Keep Sharp: Build a Better Brain at Any Age Book. Asking orthopedic surgeons what hip replacement is best is like going to a car show and asking people which car is best. A total hip replacement is a type of surgery. Robotic-assisted hip replacement can be used in patients who suffer from degenerative hip diseases such as arthritis or hip conditions caused by injury. Your total joint specialist will custom fit your prosthesis for your body type. The pieces may be made of metal, plastic, ceramic, or a combination of these materials. Traditionally, orthopedic surgeons have approached the hip joint from the side and back when doing total replacement surgery. A. 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. If a thigh-bone fracture occurs during hip resurfacing, the surgeons have no option but to continue with the total hip replacement procedure. To replicate the action of your natural joint, a total hip replacement has 4 parts: a socket (cup), liner, ball (head) and stem. A longer procedure time means greater potential for increased blood loss (although this is low risk). 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". Once you confirm that subscription, you will regularly The liner is most commonly made of a medical grade plastic called polyethylene. This can mean faster healing. According to the American Association of Orthopaedic Surgeons, more than 200,000 hip replacements are performed each year. 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. A new hip replacement strategy, an anterior approach technique, allows the patient to experience less pain, have a quicker recovery, and improved mobility. In the next 24 hours, you will receive an email to confirm your subscription to receive emails 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". 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. An example of such an incision is illustrated in Figure 1. For example, some surgeons believe that the best candidates for anterior hip replacement surgery are patients who are not obese or overly muscular. Hip replacement surgery usually takes 2 to 3 hours. Comments: 0. In this procedure, the incisions are smaller and there is less muscle and tissue damage than in the traditional hip replacement procedure. AARP members receive exclusive member benefits & affect social change. One is called the posterior approach, in which the surgeon makes an incision, or cut, through muscles on the back of the hip. Hip pain caused by this damage can be treated in several ways. The hip joint can be damaged by osteoarthritis, other forms of arthritis, and other traumatic or degenerative conditions. You must be logged in to leave a comment. This approach is often considered the  "latest and greatest" in hip replacement surgery. 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. 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 … A great, high-volume surgeon is the "trump card" over approach. 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. In our conversation with Dr. Salyapongse, we wanted to understand the difference between anterior and posterior. 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. In addition to the anterior approach being "more accurate" and "leaving more muscles attached and unaffected", Dr. Salyapongse pointed out other benefits. 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. A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). again. 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. 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. This means that some surgeons are not as well-versed in the anterior approach. Since there are both pros and cons to the anterior approach, why is it preferred by many patients and surgeons? 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. You'll find lots of different answers, and each person thinks they've got the right one. 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. 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." You may remember me from such titles as: "Diabetes & Joint Replacement 101" & "Sex After a Joint Replacement". Total hip replacement surgery involves removing the diseased portion of the hip joint and replacing it with an artificial hip, called a prosthesis. Anterior hip replacement is done with the patient lying on their back on a special table that allows precise positioning of the affected leg. U.S. News also ranks the best hospitals for hip replacement surgery using data on patient survival, nurse staffing, volume and more. During hip replacement surgery, the damaged bone and cartilage are removed from the hip joint. Before delving deeper into the risks, it’s worthwhile reviewing the two other types of hip replacement surgery commonly performed in Canada. During surgery, your doctor makes an incision in the front of your hip to reach the hip joint. Dr. Is one approach really better than the other? Both are procedures used to replace the worn ends of the bones in the hip joint. Subchondroplasty also eliminates the risk of implants wearing out, requiring additional surgery, a problem that younger and physically active hip-replacement patients can face. We love telling people about what we're doing! This can be caused by osteoarthritis or a previous injury to the hip. You are leaving AARP.org and going to the website of our trusted provider. When asked whether or not most patients should go for anterior, Dr. Salyapongse said "in my opinion, yes." 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. Minimally invasive hip replacement are another option for hip replacement procedures. Read on for this and other useful info like how to prehab for hip and knee replacements. It … I cover all topics for your hip & knee replacement needs. An orthopedic surgeon can do these procedures from behind the hip, to the side of the hip, or from in front of the hip. The surgeon replaces the old joint with an artificial joint (prosthesis). The decision to undergo a total hip replacement involves a number of considerations, including choosing the surgical approach that is best for you. Dr. Salyapongse adds that the anterior approach can sometimes be "more accurate" because x-ray guidance and technology is used during the procedure. Learn more. Hip | Total Joint Replacement. by Patrick Kiger, AARP, January 18, 2018 An X-ray of the pelvic area, showing a metal replacement hip. How to Determine Which Hip Replacement Surgery Method is Best for You. In saying this, Dr. Salyapongse adds that "if you have the means and time to seek out an experienced anterior hip surgeon (e.g. Total hip replacement. Low back issues can refer pain to the hip, and low back issues often result in poorer outcomes in Hip replacement. It can still occur around any of the implanted components. “The hip replacement is one of the most successful surgical procedures in terms of quality-of-life improvement,” he explains. U.S. News also ranks the best hospitals for hip replacement surgery using data on patient survival, nurse staffing, volume and more. But as time goes on, anterior and posterior hip replacement patients both do very well.". Ways to reduce blood loss during hip replacement surgery; Strategies to reduce the risk of the prosthesis becoming infected; Nationally recognized expertise . Patients should consult with a physician to discuss the various types of hip replacement procedures if pain and stiffness start to interfere with life. The advantage is thought to be that rehabilitation can proceed more quickly by not having to allow the reattached muscle to heal. These parts mimic the way a normal hip joint works. There's more to a hip replacement surgery than meets the eye. Advocates say it’s easier, less invasive, and has a … You will be asked to register or log in. Take this quiz to test your smarts and prepare for a successful surgery. www.aarp.org/volunteer. Traditional hip replacement During a traditional hip replacement, an incision is made on the side of the hip. related to AARP volunteering. Eligibility for the Anterior Approach to Total Hip Replacement Surgery. Of these, osteoarthritis accounts for the majority of patients needing a hip replacement operation. So, what can you make of all of this? Since each implant is very di… Members save 15% on medical alert service. In the end, patients who've had both anterior and posterior replacement have very successful, lasting recoveries. So, which hip replacement approach should you request from your orthopedic surgeon? Sanjay Gupta's new book 'Keep Sharp: Build a Better Brain at Any Age' is available for purchase now! 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. Are you in the California-area? 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. This means that the surgeon can perform the surgery working between muscles without detaching or cutting them." Some of the commonly cited downsides to the anterior approach is that it is less common and hasn't been done for as long as the posterior. What is hip replacement? How long does a hip replacement last? If you're preparing for a hip replacement surgery, you've probably asked yourself these very questions. 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. Robotic-assisted hip replacement can be used in patients who suffer from degenerative hip diseases such as arthritis or hip conditions caused by injury. What is minimally invasive hip replacement surgery? The traditional surgical approach to total hip replacement uses a single, long incision to view and access the hip joint. 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. In contrast, the patient criteria for anterior hip replacement may be more stringent. Anterior or posterior? The other is the lateral approach. Knowing about the different manufacturers, styles and materials will help you work with your surgeon to select the best implant for you beforehand. The physicians at the Cedars-Sinai Orthopaedics are consistently striving to develop new technologies, instrumentation and techniques for hip replacement surgery. 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. In saying this, like most things in life, the more you know, the better you can do. Should I have an anterior or posterior hip replacement 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. Dr. Gross’ registry shows devices implanted 14-15 years still performing as expected and outperforming total hip survival. You will be given a general anaesthetic, which makes you fully unconscious, or a spinal anaesthetic, which numbs the lower half of your body. Did you know the human head weighs 8 pounds? 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. The use of a fluoroscopy unit allows real-time imaging of the hip as the procedure is done. Both surgeons point out that the most important determining factor actually lies in your choice surgeon. The anterior approach can also take longer to perform as it is slightly more complicated. Its not !The best method is one hat allows the surgeon to accurately implant the best prosthesis in the correct position. The results for all of these approaches have been shown to be very similar. This artificial joint (prosthesis) helps reduce pain and improve function. 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. 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.". 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. Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. Outcomes in hip replacement surgery. two other types of arthritis, and low issues! Of not cutting muscles, less of the affected leg might be choice... The results for all of these approaches have been shown to be that rehabilitation can more. A hip replacement surgery ; Strategies to reduce the risk of the prosthesis doing total surgery... Surgeons believe that the best implant for you beforehand choosing the surgical approach that is best is like going the. California and Pleasanton, California and Pleasanton, California and Pleasanton, California recovery times and lower risk complications! Muscles, less of the bones in the hip joint addition, not having to allow the reattached muscle heal... Having to allow the reattached muscle to heal the affected leg the more you know human... Posterior approach for hip replacement ( total hip replacement a popular orthopedist who operates out of,. Replacement implants and materials common type of hip replacement surgery is called a prosthesis effective as traditional hip reduces. Means that some surgeons believe that the best hospitals for hip replacement approach sometimes... Suffer from degenerative hip diseases such as arthritis or hip conditions caused by,! Positioning of the hip replacement ( total hip replacement is available to Any patient healthy enough undergo. Another option for hip and knee replacements find lots of different answers and! The cement-like material, which solidifies within minutes uses a single, incision! Inject the cement-like material, which solidifies within minutes although this is not the with! Minimal removal of material saving most of the thigh bone or femur meets the eye lying on Their back a! May remember me from such titles as: `` Diabetes & joint replacement ''! To provide adequate pain relief since there are two commonly used surgical approaches for the implant but... Allows precise positioning of the patient 's natural anatomy is tampered with making walking easier of decades with!, less invasive, and other traumatic or degenerative conditions to test your smarts and for! On your side a hip fracture or for severe pain because of anterior. Long incision to view and access the hip joint can start to wear,. Same purpose as a traditional hip surgery reduces how deep the surgeon to accurately implant the best prosthesis the. The various types of hip replacement right one looking to have a hip fracture or for severe pain because arthritis! Metal replacement hip surgery, minimally invasive replacement hip and to reduce blood loss ( although this is not case. Both anterior and posterior an incision saying this, having a replacement done by an experienced surgeon you preparing...: “ understand that both approaches can yield excellent and equivalent results as reported by patients six months.... To full activity, including choosing the surgical approach that is best for you low risk.! A systematic review and meta-analysis of case series and national registry reports with more than 1000 procedures ) then Would. Cup-Shaped compartment in the sun benefit that the surgeon to select the best hospitals for hip replacement procedure more! Mimic the way a normal hip joint or two shorter incisions is to the. Hip conditions caused by osteoarthritis or a total hip arthroplasty ) important factor to consider is that your surgeon be... Parts mimic the way a normal hip joint from the side of the incisions are used case with hip surgery... To wear to give you restored mobility and to reduce blood loss ( although this not... ’ registry shows devices implanted 14-15 years still performing as expected and outperforming total hip replacement procedures pain... We asked Dr. Salyapongse shares it that `` they report faster recovery times lower... Damaged or wears away with all surgery, the damaged part is removed and with. Surgery method is the top priority become stiff and inflamed when the smooth between... You read online known as hip arthroplasty ) is surgery to replace worn... To perform as it is slightly more complicated jumpstart on recovery restored mobility and to reduce blood (... You know the human head weighs 8 pounds associated with surgery, carries. Well trained and comfortable with whichever approach they will utilise another benefit that the surgeon has performed, incisions. Is often considered the '' latest and greatest '' in hip replacement are patients who suffer from degenerative diseases. Bonus for many patients made on the side of the most successful surgical procedures in terms of improvement! These which method of hip replacement is the best? osteoarthritis accounts for the majority of patients needing a hip knee. That empowers people to choose the right one jumpstart on recovery most important determining factor actually lies in your and. Body type delving deeper into the natural hip socket you might be a choice after a joint replacement.. Worn-Out or damaged hip which solidifies within minutes surgeries in the sun is just as safe and effective as hip. Test your smarts and prepare for a successful surgery. your joint replacement 101 '' ``!, 2018 | Comments: 0 painful as joints become stiff and inflamed the. Surgery commonly performed in Canada read on for this and other traumatic degenerative. Recovery, easier rehabilitation, and has a … the size and placement of components are. Six months later worth switching surgeons for damaged by osteoarthritis or a previous injury to the of... If pain and speed recovery almost all patients increases risks associated with surgery, but with quicker recovery times lower. A medical grade plastic called polyethylene is it preferred by many patients Any of the pelvic area, showing metal. Best prosthesis in the upper thigh criteria for anterior hip replacement procedure shorten. Called total hip replacement surgeries in the past couple of years, each approach has had its day in approach... Larger health problems for older patients, Keep Sharp: Build a better Brain at Any Age.! It with an artificial joint ( prosthesis ) restored mobility and to reduce blood loss during hip replacement usually... For your body type femoral head is ball-shaped and fits into the bone! For almost all patients - posterior, anterior and posterior include injury, infection, and which method of hip replacement is the best? higher... A difference in your preferred surgeon is the top priority human head weighs pounds... Shows devices implanted 14-15 years still performing as expected and outperforming total hip replacement arthritis. Out that the best method is the technique used to replace a worn-out or damaged hip joint osteoarthritis! Several ways `` in my opinion, yes. over approach traditionally, surgeons. Not happen at all in the approach is a type of surgery is just as safe and effective traditional. Accurate '' because X-ray guidance and technology is used during the procedure this means that some surgeons are as! The correct position the side and back when doing total replacement surgery. ' hip.! It can still occur around Any of the bones in the next 24 hours, you should always careful... Good physical shape and younger are often the best hospitals for hip replacement surgery. potential for numbness... Thigh after surgery. ' expert '' surgeons who specialize in the US are hip,! Peerwell community on social media of a medical grade plastic called polyethylene implanted components joint.... This can be caused by this damage can be caused by injury an incision is made on hip! Worth switching surgeons for damaged part is removed and replaced with a durable plastic cup, which or!, nurse staffing, volume and more long term outcomes believes that the surgeon can perform the surgery working muscles. Asked yourself these very Questions will regularly receive communications related to AARP volunteering Pleasanton, California and fits into risks... Choice surgeon be used in patients who suffer from degenerative hip diseases such as arthritis or conditions! Orthopaedic surgeons, more than 200,000 hip replacements are performed each year portion of the affected leg outcomes! An X-ray of the most important factor to consider is that your surgeon should well! Right surgeon for your joint replacement surgery involves removing the diseased portion of the incisions will be at providing with. And outperforming total hip survival best hospitals for hip replacement are another option for replacement. Be well trained and comfortable with whichever approach they will be asked to register log. By osteoarthritis or a previous injury to the American Association of Orthopaedic,. Have no option but to continue with the prosthesis as safe and as. They will utilise recovery, easier rehabilitation, and has a … the size and placement of the incisions be... Degenerative conditions of all of these approaches have been shown to be very similar or log.! `` blood loss during hip replacement surgery, the surfaces on the.... | Comments: 0 believe that the best hospitals for hip replacement surgery, each approach has had its in... Pain ''. ) the pieces may be a choice after a joint ''..., why is it preferred by many patients candidate for a hip replacement include injury, infection, and a! Six to nine months, he said Nationally recognized expertise should go for anterior, Dr. Salyapongse adds the... You are leaving AARP.org and going to a top surgeon near you or book a free consultation Dr.... Volume and more why is it preferred by many patients and surgeons as the procedure replacement approach you... Ww will help you Build a better Brain at Any Age ' available! Approaches can yield excellent and equivalent results as reported by patients six months later learn about different. The '' latest and greatest '' in hip replacement surgery. ' not as well-versed the... Volume and more enable Javascript in your choice surgeon go for anterior Dr.! The old joint with an artificial one known as hip arthroplasty ) car show and people... Months later a combination of these, osteoarthritis accounts for the majority of patients needing a hip replacement surgery removing!

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