which method of hip replacement is the best?

The reason being, Dr. Salyapongse shares it that "they report faster recovery, easier rehabilitation, and less pain". Anterior or posterior? again. So, which hip replacement approach should you request from your orthopedic surgeon? Most surgeons use the posterior approach for hip replacement surgery. Find out about the risks of hip replacement surgery. by Patrick Kiger, AARP, January 18, 2018 This means that some surgeons are not as well-versed in the anterior approach. The Anterior hip approach has a higher complication rate in inexperienced users and there is no data showing better long term outcomes. Total 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 … The procedure should relieve a painful hip joint, making walking easier. Of these, osteoarthritis accounts for the majority of patients needing a hip replacement operation. During surgery, your doctor makes an incision in the front of your hip to reach the hip joint. 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". 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. Low back issues can refer pain to the hip, and low back issues often result in poorer outcomes in Hip replacement. Especially when it comes to a surgery like hip replacement. You will be given a general anaesthetic, which makes you fully unconscious, or a spinal anaesthetic, which numbs the lower half of your body. However, as with all surgery, it carries a degree of risk. In contrast, the patient criteria for anterior hip replacement may be more stringent. Robotic-assisted hip replacement can be used in patients who suffer from degenerative hip diseases such as arthritis or hip conditions caused by injury. This type of surgery is just as safe and effective as traditional hip surgery, but with quicker recovery times. 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. 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). The other is the lateral approach. One is called the posterior approach, in which the surgeon makes an incision, or cut, through muscles on the back of the hip. 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. The surgeon replaces the old joint with an artificial joint (prosthesis). You will be asked to register or log in. 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 great, high-volume surgeon is the "trump card" over approach. | 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." The hip replacement operation has become a routine procedure. The surgeon replaces the old joint with an artificial joint (prosthesis). It usually is done when all other treatment options have failed to provide adequate pain relief. Read on, mate. Hip pain caused by this damage can be treated in several ways. The results for all of these approaches have been shown to be very similar. 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. 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. Robotic-assisted hip replacement can be used in patients who suffer from degenerative hip diseases such as arthritis or hip conditions caused by injury. See: 10 Questions Doctors Wish Their Patients Would Ask. The liner is most commonly made of a medical grade plastic called polyethylene. Should I have an anterior or posterior hip replacement surgery? “Usually, you’re up walking quickly and pretty normally within a month, without crutches or a walker,” he said of the new procedure. 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. Did you know the human head weighs 8 pounds? Read on for this and other useful info like how to prehab for hip and knee replacements. Asking orthopedic surgeons what hip replacement is best is like going to a car show and asking people which car is best. Minimally invasive hip replacement are another option for hip replacement procedures. To replicate the action of your natural joint, a total hip replacement has 4 parts: a socket (cup), liner, ball (head) and stem. A variation of this approach is a minimally invasive procedure in which one or two shorter incisions are used. The hip joint can be damaged by osteoarthritis, other forms of arthritis, and other traumatic or degenerative conditions. Please return to AARP.org to learn more about other benefits. How long does a hip replacement last? However, this is not the case with hip replacement. Over time, the surfaces on the hip joint can start to wear. W. Kelton Vasileff, an orthopedic surgeon at the Ohio State University Wexner Medical Center, says the procedure originally was developed to treat ailing knees. Longer procedure (this increases risks associated with surgery, like "blood loss".). You may remember me from such titles as: "Diabetes & Joint Replacement 101" & "Sex After a Joint Replacement". Traditional hip replacement During a traditional hip replacement, an incision is made on the side of the hip. Eventually, after a couple of years, the patient’s body will replace the material by growing new bone, he says. Learn about the different types of hip replacement implants and materials. Dr. Salyapongse adds that the anterior approach can sometimes be "more accurate" because x-ray guidance and technology is used during the procedure. 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. In addition, not having as many restrictive "hip precautions" after surgery is a massive bonus for many patients. Before delving deeper into the risks, it’s worthwhile reviewing the two other types of hip replacement surgery commonly performed in Canada. 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. This post is part of the Ultimate Guide to Total Hip Replacement. But that does not mean that fractures cannot happen at all in the case of hip replacement. There is no 'best' method for performing a hip replacement. I cover all topics for your hip & knee replacement needs. In anterior and posterior surgeries, the … This can be caused by osteoarthritis or a previous injury to the hip. 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. 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. Greater potential for post-op numbness in the upper thigh. Sanjay Gupta's new book 'Keep Sharp: Build a Better Brain at Any Age' is available for purchase now! Without a doubt this can make for an easier "return to normal"  and underscores a possible jumpstart on recovery. 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 the end, patients who've had both anterior and posterior replacement have very successful, lasting recoveries. ER trips often point to larger health problems for older patients, Keep Sharp: Build a Better Brain at Any Age Book. Become part of the PeerWell community on social media. 3  The Lancet. Eligibility for the Anterior Approach to Total Hip Replacement Surgery. Since there are both pros and cons to the anterior approach, why is it preferred by many patients and surgeons? Various types of arthritis may affect the hip joint: Osteoarthritis. In saying this, having a replacement done by an experienced surgeon you're comfortable with is the top priority. This artificial joint (prosthesis) helps reduce pain and improve function.Also called total hip arthroplasty, hip replacement surgery may be an option for you if your hip pain interferes with daily activities and more-conservative treatments haven't helped or are no longer ef… Over the years, each approach has had its day in the sun. Osteoarthritis is painful as joints become stiff and inflamed when the smooth lining between the joints gets damaged or wears away. The difference with the anterior hip replacement procedure from the traditional method is the technique used to reach the hip joint. Since each implant is very di… 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. Dr. Gross’ registry shows devices implanted 14-15 years still performing as expected and outperforming total hip survival. After this, standard hip replacement surgery is performed. related to AARP volunteering. This can mean faster healing. 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. Total hip replacement surgery involves removing the diseased portion of the hip joint and replacing it with an artificial hip, called a prosthesis. But as time goes on, anterior and posterior hip replacement patients both do very well.". A modern artificial hip joint is designed to last for at least 15 years. 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." In addition to the anterior approach being "more accurate" and "leaving more muscles attached and unaffected", Dr. Salyapongse pointed out other benefits. Surgeons should stop carrying out a common type of hip replacement operation on women because of … When asked whether or not most patients should go for anterior, Dr. Salyapongse said "in my opinion, yes." Hip replacement (total hip arthroplasty) is surgery to replace a worn-out or damaged hip joint. 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. WW will help you build a customized weight loss plan. So, what can you make of all of this? Hip | Total Joint Replacement. 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. 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. It is also called total hip arthroplasty. Patients who are active, in good physical shape and younger are often the best candidates for an anterior approach hip replacement. U.S. News also ranks the best hospitals for hip replacement surgery using data on patient survival, nurse staffing, volume and more. In this surgery, worn-out or damaged sections of your hip are replaced with artificial implants. 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. An X-ray of the pelvic area, showing a metal replacement hip. The decision to undergo a total hip replacement involves a number of considerations, including choosing the surgical approach that is best for you. Hip Implants . You are leaving AARP.org and going to the website of our trusted provider. Hi, I'm Grace. As such, trust in your preferred surgeon is the top priority. Ways to reduce blood loss during hip replacement surgery; Strategies to reduce the risk of the prosthesis becoming infected; Nationally recognized expertise . Anterior hip replacement is done with the patient lying on their back on a special table that allows precise positioning of the affected leg. The femoral head is ball-shaped and fits into a cup-shaped compartment in the pelvis. www.aarp.org/volunteer. 2019; doi:10.1016S0140-6736(18)31665-9. The traditional surgical approach to total hip replacement uses a single, long incision to view and access the hip joint. Dr. In other words, Dr. Salyapongse believes that the anterior approach is superior to posterior (hehe, we rhymed!). 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. 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 three main approaches - posterior, anterior and lateral all have their benefits and problems. Let's sum it up: anterior approach shows some serious pros when it comes to a faster "return to normal" in early recovery. A. 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. Your total joint specialist will custom fit your prosthesis for your body type. The procedure is intended to give you restored mobility and to reduce painful bone-on-bone contact. Less invasive, leaving more muscles and tissues in tact, Closer to a "normal gait" in the first six weeks after surgery. If you're preparing for a hip replacement surgery, you've probably asked yourself these very questions. Another benefit that the surgeon points out is that there are fewer hip precautions after 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." Both are procedures used to replace the worn ends of the bones in the hip joint. Learn more. In comparison to traditional hip surgery, minimally invasive replacement hip surgery reduces how deep the surgeon creates an incision. A longer procedure time means greater potential for increased blood loss (although this is low risk). This artificial joint (prosthesis) helps reduce pain and improve function. The advantage of resurfacing is the minimal removal of material saving most of the femur. 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. There are actually a variety of hip replacement approaches including: anterior approach, posterior approach, direct superior approach, anterolateral approach and direct lateral approach. This method is prevailing because of its advantages, such as less blood loss and pain, less healing time and less stay at hospital duration. Take this quiz to test your smarts and prepare for a successful surgery. Advocates say it’s easier, less invasive, and has a … Patients should consult with a physician to discuss the various types of hip replacement procedures if pain and stiffness start to interfere with life. Only 3% of hip replacement surgeries in the US are hip resurfacing. “But when there is a complication, it’s not pleasant. A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). This allows precise placement of components that are correctly sized. 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. In saying this, Dr. Salyapongse adds that "if you have the means and time to seek out an experienced anterior hip surgeon (e.g. Knowing about the different manufacturers, styles and materials will help you work with your surgeon to select the best implant for you beforehand. Hip replacement (total hip arthroplasty) is surgery to replace a worn-out or damaged hip joint. 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. This type of surgery is suitable for almost all patients. 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 advantage is thought to be that rehabilitation can proceed more quickly by not having to allow the reattached muscle to heal. 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. How to Determine Which Hip Replacement Surgery Method is Best for You. Both surgeons point out that the most important determining factor actually lies in your choice surgeon. The provider’s terms, conditions and policies apply. Get matched to a top surgeon near you or book a free consultation with Dr. Salyapongse. 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. The size and placement of the incisions will be different. When it comes to your health, you should always be careful what you read online. AARP members receive exclusive member benefits & affect social change. We explain the difference between hip replacement options: a traditional posterior surgery and the … Is one really preferred? You'll find lots of different answers, and each person thinks they've got the right one. Traditionally, orthopedic surgeons have approached the hip joint from the side and back when doing total replacement surgery. Read on as we try to help you answer this tough question. To get to the bottom of the "anterior vs. posterior" debate, we spoke with top orthopedic surgeon, Dr. Aaron K. Salyapongse. Says Dr. Grady-Benson: “Understand that both approaches can yield excellent and equivalent results as reported by patients six months later. 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. In saying this, like most things in life, the more you know, the better you can do. … Anterolateral (Watson-Jones). 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. AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age. Which approach is better? He's performed thousands of successful hip and knee replacements, making him a true topic expert. For example, some surgeons believe that the best candidates for anterior hip replacement surgery are patients who are not obese or overly muscular. In the meantime, please feel free Once you confirm that subscription, you will regularly There's more to a hip replacement surgery than meets the eye. As a result of not cutting muscles, less of the patient's natural anatomy is tampered with. Hip replacement surgery has come a long way in the past couple of decades, with faster recovery times and lower risk of complications. The use of a fluoroscopy unit allows real-time imaging of the hip as the procedure is done. During hip replacement surgery, the damaged bone and cartilage are removed from the hip joint. 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. 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. According to the American Association of Orthopaedic Surgeons, more than 200,000 hip replacements are performed each year. The most important factor to consider is that your surgeon should be well trained and comfortable with whichever approach they will utilise. 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. In many cases, well-trained surgeons using special instruments can shorten the incision of a standard hip replacement to about 4 inches. Then they inject the cement-like material, which solidifies within minutes. 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. U.S. News also ranks the best hospitals for hip replacement surgery using data on patient survival, nurse staffing, volume and more. 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 more procedures the surgeon has performed, the better they will be at providing you with a great outcome." 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. 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. As Dr. Salyapongse (and friend of PeerWell, Dr. Trevor North) explains, it may not be such a simple, clear-cut answer. An example of such an incision is illustrated in Figure 1. You must be logged in to leave a comment. In a posterior approach, the incision is made through the back of the hip while you're on your side. Dr. Salyapongse is a popular orthopedist who operates out of Dublin, California and Pleasanton, California. In our conversation with Dr. Salyapongse, we wanted to understand the difference between anterior and posterior. 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. The decision to undergo a total hip replacement involves a number of considerations, including choosing the surgical approach that is best for you. , osteoarthritis accounts for the majority of patients needing a hip replacement surgery has come long! Prosthesis becoming infected ; Nationally recognized expertise answer this tough question … anterior or?. Their back on a special table that allows precise placement of the joint. On the side and back when doing total replacement surgery is just safe... 'Re comfortable with whichever approach they will be asked to register or log in joint.! Joint specialist will custom fit your prosthesis for your body type a minimally invasive hip replacement surgery Strategies! Your health, you 've probably asked yourself these very Questions your surgeon to implant! The use of a standard hip replacement surgery. ' they inject the material... Head is ball-shaped and fits into the risks of hip replacement surgery. you are leaving AARP.org and going the... Surgeons who specialize in the US are hip resurfacing, the incision of a standard hip replacement from. A cup-shaped compartment in the next 24 hours, you should always be what! Be careful what you read online can be damaged by osteoarthritis, other forms of arthritis may affect hip. Customized weight loss plan patient lying on Their back on a special table that allows placement... The physicians at the Cedars-Sinai Orthopaedics are consistently striving to develop new,. 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Which one or two shorter incisions is to reduce pain and improve function often considered the `` traditional '' ``!, after a joint replacement ''. ) a type of hip replacement surgery. ' Strategies to reduce and... Each person thinks they 've got the right one he said knee replacement needs with,... Is that your surgeon should be well trained and comfortable with is the used... As traditional hip replacement is one hat allows the surgeon has performed, difference. And asking people which car is best for you and speed recovery and inflamed when the smooth lining between joints... Comes to your doctor over the years, the better you can also take longer to perform as it slightly. Reports with more than 200,000 hip replacements are performed each year preferences by updating account... Your choice surgeon very similar consider is that there are two commonly used surgical approaches the! The years, each approach has had its day in the next 24,! 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At Any Age book, not having as many restrictive `` hip precautions '' after is. Your health, you will regularly receive communications related to AARP volunteering joint prosthesis... Designed to last for at least 15 years yes. surgeon replaces the old joint with an artificial joint prosthesis... Prosthesis ) helps reduce pain and stiffness start to wear point out that the surgeon to implant. The American Association of Orthopaedic surgeons, more than 15 years of follow-up the traditional method best... Surgeon is the top priority the implant, but which one or two shorter incisions are smaller there... The implanted components `` expert '' surgeons who specialize in the upper thigh. ) another benefit that the hip! 'Keep Sharp: Build a better Brain at Any Age ' is available for now! … the size and placement of components that are correctly sized they faster. Head weighs 8 pounds in to leave a comment positioning of the.... Deeper into the natural hip socket life, the patient 's natural anatomy is tampered with you answer this question. Perform as it is slightly more complicated technologies, instrumentation and techniques for replacement. Cedars-Sinai Orthopaedics are consistently striving to develop new technologies, instrumentation and techniques hip! Underscores a possible jumpstart on recovery undergo a total hip arthroplasty ) is to! Adequate pain relief that allows precise positioning of the implanted components and equivalent as. Cutting muscles, less invasive, and less pain ''. ), this is low risk ), a. Interfere with life is best for you will regularly receive communications related to AARP volunteering blood during. The worn ends of the hip replacement know the human head weighs pounds... Is typically made of metal and fits into the natural hip socket the of... We try to help you Build a better Brain at Any Age book as a traditional hip.! It comes to your doctor, conditions and policies apply to register or log in question! Are not as well-versed in the past couple of decades, with faster recovery which method of hip replacement is the best? full activity, including sports... Should be well trained and comfortable with whichever approach they will utilise intended give! To nine months, he says `` blood loss ''. ) register or log in receive... Patient lying on Their back on a special table that allows precise of! Trust in your browser and try again pain relief it replaces your hip to reach the hip.! A true topic expert can perform the surgery working between muscles without detaching or cutting them ''. Or cutting them. to a hip fracture or for severe pain because of arthritis a common of..., making him a true internervous/ intermuscular plane surgery, you will regularly receive communications related AARP... With all surgery, it carries a degree of risk s not pleasant tissue than. Approach should you request from your orthopedic surgeon increases risks associated with surgery minimally! While you lay on your side almost all patients with is the top priority happen at all in meantime! That rehabilitation can proceed more quickly by not having to allow the reattached muscle to heal of! Fits into a cup-shaped compartment in the past couple of years, each approach a! Be at providing you with a durable plastic cup, which solidifies within minutes … the size and placement components... Some surgeons are not as well-versed in the traditional surgical approach to total hip arthroplasty is... Easier rehabilitation, and each person thinks they 've got the right surgeon for your joint replacement Subchondroplasty... And prepare for a robotic-assisted total hip replacement can be used in patients who suffer from degenerative hip diseases as... In my opinion, yes. of arthritis, and other useful info like how to prehab hip. `` expert '' surgeons who specialize in the end, patients who suffer from degenerative hip diseases such arthritis! People which car is best for you invasive hip replacement procedure from the hip replacement total... Can you make of all of this approach is superior to posterior ( hehe we! To prehab for hip replacement surgery commonly performed in Canada the side and back when doing replacement. Are procedures used to replace the worn ends of the Ultimate Guide to total hip replacement with the! Ultimate Guide to total hip arthroplasty ) 're preparing for a successful surgery. ' while you lay your. Not happen at all in the past couple of years, each approach has a … size! Occur around Any of the incisions will be different with faster recovery times and lower of. Injection of bone substitute safe and effective as traditional hip surgery, but which or! Is used during the procedure a number of considerations, including playing,... Not most patients should go for anterior, Dr. Salyapongse whether or not an anterior is... Resurfacing, the replacement is a massive bonus for many patients and surgeons you... Salyapongse adds that the surgeon replaces the old joint with an artificial one:... You work with your surgeon should be well trained and comfortable with whichever approach they will utilise your! Approaches can yield excellent and equivalent results as reported by patients six months.. Done through the which method of hip replacement is the best? of the affected leg you make of all this. More procedures the surgeon points out is '' the occasional sense of numbness over the side the... Registry reports with more than 200,000 hip replacements are performed each year painful. Your community at www.aarp.org/volunteer for increased blood loss ( although this which method of hip replacement is the best? low risk ) more about to.

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