"Anterior" Hip Replacement-Is is Better? Precautions & Exercises.
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- Опубліковано 3 сер 2017
- "Famous" Physical Therapists Bob Schrupp and Brad Heineck discuss the pros and cons of an Anterior (Front) Approach Total Hip Replacement versus a "Posterior" (Back) Approach Total Hip Replacement. They also discuss common precautions & exercises to follow after the Anterior Approach Total Hip Replacement.
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I had a left anterior approach hip replacement 1 week ago. I stayed overnight as I live alone & just didn't feel safe, otherwise. Had PT the first day who showed me how to use a walker & how to go up stairs. I walked with the walker & went up a few stairs the first day. The next day had OT who went through using devices to pick up things, putting on socks, & getting off footwear (sent me home with them). Best thing OT showed me was how to use a sheet as a sling to raise & abduct my leg to get into bed & a car. This activity was the most difficult & painful for me. Maybe because I am overweight & the swelling made my leg heavier. I reserved narcotic pain medication for getting into bed @ night & be painfree in order to sleep. Otherwise, used Tylenol, Naproxen, & Baby ASA around the clock. Baby ASA was also to help prevent blood clots from forming. The first 2 days I applied ice for additional pain relief & keep down swelling. The metal is Titanium. Cementless. Ceramic ball. My toilet seats are low so I found the raised seat with armrests that I purchased on Amazon very helpful. I also found the tub transfer seat that I purchased on Amazon very helpful as I don't have a walk-in shower. Good luck everyone. Still need to do my other hip down the road.
Thanks for an informative review of the anterior approach Total Hip Replacement, Bob and Brad. I'm a retired PA-C and was first assistant in approximately 1500 of these procedures. Just a couple minor points mentioned early in your review. Cement is rarely used for the metal implants in both the femur and acetabulum. They are typically a titanium alloy. Modern implants have irregular surfaces sometimes with bioactive coatings or Vitamin E to promote bone growth integration and prevent bacterial growth. They are termed as "press fit" after the femoral canal and acetabulum has been broached or reamed to the appropriate size. They are literally hammered in place with a mallet to set them in the appropriate position. Usually a ceramic or ceramic metal head is cold fused to the tapered end of the femur implant while a highly durable polyethylene liner is locked into the acetabular cup. Hope this helps. You guys provide a ton of useful rehab info!
Guys, first off I really enjoy your channel. However, as an orthopedic surgeon, who is trained to do both anterior and posterior approaches I must say you may have unintentionally mislead your viewers. The difference in dislocation from modern posterior approach and anterior approach is 1 percent. It is the same, not ten times better. The difference is that one dislocates anterior and one dislocates posterior. The lowest dislocation rate is the anterolateral approach which is neither anterior or posterior. You may want to mention a mini posterior approach, which is pretty much standard today, has recovery equal or better than anterior in some reported studies. Let's not forget the worse acetabular component positioning, psoas tendinitis and recently reported increase femoral loosening rates with the direct anterior approach. Let alone increased femoral fracture risks, tensor fascia lata damage, increased blood loss and lateral femoral cutaneous nerve injury. Furthermore, the anterior approach can be done on a regular OR table. I think patients get confused about approaches and have believed marketing hype (yes, hospitals and surgeons do market themselves for increased business). When you look at peer reviewed literature and follow up, you'll find the truth. There are advantages and disadvantages to both approaches with neither being superior. Look how hip resurfacing has essentially ceased to exist, whereas, 10 years ago it was the rage. What happened? Follow up studies. I would stress to any of your followers looking into joint replacement that component positioning, re establishing the hips center of rotation and offset to re establish muscle tension determines optimal recovery, function and wear and no approach will solve that problem. That intrinsically makes sense., doesn't it? The best option for patients is a CT guided computer navigated robotic arm assisted surgery. Stryker's MAKO is the only one on the market. I do use this system for all my replacements, hips, total and partial knees and it's striking the difference in recovery.(I have no financial ties) Harris hip and UCLA activity score show robotic MAKO hips perform better at a year than manual hips. Refer to the research paper done at Mass. General that showed of 1853 total hips, 53 percent of the acetabular component were positioned out of the safe zone( incorrectly). To their credit they published that data. They are fantastic surgeons but it demonstrates the difficulties of correctly performing this surgery, regardless of approach. Poor positioning of the hip replacement leads to increased wear, loosening , dislocation, impingement, psoas tendonitis , poor function, leg lengthening and early failure. Patients are too focused on approach and not what matters which is putting the components in the correct position. There is an assumption that all components will obtain correct position and the approach is the modifier. This simply isn't true. Anyway, enough of my rambling. Keep up the good work. Excuse any grammatical errors I didn't proof read.
I've had both hips replaced by the Anterior approach. I walked using one crutch 3 hours after surgery; I bent over and tied my shoes, got dressed and went home the next day. I used the one crutch for 6 days. Done. Started walking around the block increasing distance each day; went to Pilates Class at 3 weeks out. I went back to work in 10 days. I have tiny barely visible 3" scars, and best of all it gave me my life back! I hike, go to 3-4 Pilates classes a week, use the elliptical trainer, treadmill, etc. And for God's sake!!! Do not go to a rookie - go to an ace who has done hundreds. We're really lucky in Los Angeles. Joel Matta M.D. Has trained a group of surgeons who are all aces. Accept no substitutes!
Thank you i’ve had a total of 7 hip replacements and 12 dislocations i’ve had both anterior and posterior people need to educate themselves and don’t be afraid to ask or challenge your surgeon to get what isright for you
I’m going to be scheduled for an anterior hip replacement within the next month. I’m totally looking forward to it, I asked my doctor to get this taken care of so I could have this done the way I needed it done
In 2018 I had the posterior and the surgeon had performed over 2,000 procedures and the outcome was positive. We did discuss the lateral posterior and we did discuss the full hip replacement called posterior and the direct anterior but the hospital did not yet have the table for the interior. It is now 2021 and my orthopedic surgeon only performs the direct anterior approach and that's the one I will have in September 2021. The first procedure required a half day educational seminar for all patients which was good and it came with a book that we had to read which included post-op exercises. You are correct that the table cost is around $100,000. Approximately 60% of all full hip replacements are in America the posterior approach but that number is changing as new orthopedic surgeons are trained to use the anterior approach. You are correct that the full hip replacement using the interior approach is better for the patient. I have learned so much when it comes to physical therapy as a patient from your channel so thank you.
Had anterior done 2 and one half months ago. Biggest issue was pain around the incision and hip muscles. Just now able to sleep better. And in my mind good sleep really helps the healing process. Thanks for this video. Amazing how much more common the anterior approach is now - five years after this video was shot.
Great video very good info and demo just had any hpi repl
I had both hips replaced anterior and it was such a great experience
"If you can't be handsome, be handy!", says Red Green. Words to live by for men.
Thanks guys, you're adorable and you seem to be the only ones making the clear distinction of what type of surgery and what the dos and don'ts are. Maybe do an update now that the surgery is so much more common? :-)
You guys are great...thankyou!!
Wow, great team and excellent explanation as I'm doing a report on Total Ship anterior approach. Thanks The handyman 🛠️🛠️ . May you also do one on knee replacement? (Surgery)
Good information. 👍
u 2 r great!👍 thanks for all d inputs.. n luv yr jokes 😊🙏💜
May 2022 I just had Anterior at age 74. After than more than 1/2 year of hip bone on bone with extreme pain. I have no hip pain, minor muscle pain as these muscle have not been used for last 1 1/2 years. I could walk with minimal pain day of surgery & walked around block within week with walker. By 12 weeks walking > 2 km daily with walking sticks. Increasing range slowly. ROM(Range of Motion) exercises are a MUST, to give you full mobility. My surgeon did an Amazing job. He has done over 3,000 Anterior THR.
thanks for sharing
Have to have right hip replacement waiting to see Dr. My hip definitely hurts
Had a total RTHR anterior approach in Feb. Dislocated 5 weeks after surgery. Surprisingly you discuss Anterior precautions, I was released with none. The orthopedic doctor didn't even want me to pursue a PT program to rehab. TBH I have not been the same since the procedure, and dislocation. I have severe scoliosis which I believe is making matters worse. My hip flexor/psoas area is extremely tight, and every time I go to work the glute and hip muscle group I am making things worse (perhaps hip tendonitis?) .