DIRECT ANTERIOR vs POSTERIOR approach to the hip l Total Hip Replacement lon-table vs off-table /DAA

[@bajajudy8003]

Thank you very much!! I was worried about getting the posterior approach. Everyone is saying anterior, anterior but I have selected based on my surgeon and he performs posterior. This helps to put my mind at ease.

[@dradamrosen]

Glad it helped!

[@kittyg2718]

just come across your channel. I had posterior surgery five weeks ago, I know people who have had anterior and seemed to have less pain, I have had pain off and on, I spoke with the surgeon and he arranged an appointment to see him last week and to also have a X-ray, everything was fine with the implant, I was told my pain was inflammation, I am hopeful that I will soon be 100% In truth I chose the surgeon myself I travelled three hours to allow this surgeon to operate on my hip, when I could have travelled 15 min to another hospital, why because I felt comfortable with my choice of surgeon, I read his bio and I was impressed, but the big factor was I liked the man he was, he did not rush me into surgery and I felt he cared about my future plans once I was fully recovered, I never asked why he chose the posterior approach.

[@dradamrosen]

A good relationship with your doctor is always important. Wishing you a speedy recovery.

[@edgaracevedo9658]

I have a stomach pouch so surgeon will use posteral approach for my operation.

[@kittyg2718]

@@dradamrosen since I wrote this post two months ago, I have been in pain, recently I had a MRI, the outcome was that my hip replacement is perfect no problems, however I have 9cm x 3cm of fluid adjacent to the right greater trochanter, suggesting a distended trochanteric bursa/bursitis with minor heterogeneity in the short rotator tendon/tendinopathy, there is also minor heterogeneity in the distal psoas tendon, do I have a clue what all this means, NO! all I know is that it is painful and I am doing all I can to recover, seeing the physio twice a week, doing my rehab exercises, I am a glass half full person, the good news is there is nothing wrong with my hip replacement, I have never regretted my surgeon choice he did a great job, I feel I have been unlucky, but I will find a way to recover and get back to full fitness!

[@kittyg2718]

@@edgaracevedo9658 Good luck with your surgery, I wish you well

[@edgaracevedo9658]

@kittyg2718 Thanks. Weird but the pain goes away after a 10 minute cold bath. I have pain on the side of hip.

[@pwabbit]

Great information. It's hard to know which approach is not just better, but better for my hip anatomy.

[@dradamrosen]

Glad it was helpful!

[@alwas8916]

great info. the Dr. i found is very positive and claims i'll do well. his attitude towards me imo is half the battle! plus people i have met gave him great reviews and positive outcomes. goin' for it on 9/16/24... i can not wait to have the excruciating pain gone! thanks for the one vs the other. i am having the posterior. just in case there are other problems. 😊

[@arrowheaddev]

Great video , I have had 2 hips done in the past the last year both anterior Both have turned out great . I am 59 and had really bad arthritis First one had zero issues walking unaided in first week , riding the bike week 3 and in the gym every day till back to work at week 12 I’m now 16 weeks post op on the second one This one had a nerve complication , my femoral nerve was injured / compressed during surgery and I had almost total quad palsy I worked crazy hard at getting things moving again and by week 5 ish I was able to start Pilates which really helped Now I’m still in the gym 5 days a week , lots of hiking in the mountains , back to cross fit , Mtn biking . Strength is almost back to normal , doing 400 lb leg press , Bulgarian split squats , box jumps , dead lifts and almost a pistol squat with my first hip I had very little pain , more pain from the arthritis than the surgery , tramadol for 4 days then Tylenol and Advil for 3 weeks Looking forward to skiing and hockey this coming winter ! Other than the nerve issue the anterior was great I forget I’ve had them done Extremely grateful to have my life back

[@dradamrosen]

Yes, the femoral nerve palsy is a real but low risk of the anterior. Glad to hear you recovered. Enjoy the slopes and the rink.

[@TimFitzhenry]

Thank you doctor for your thoughts. The healing might also take longer as I had a heart transplant 6 years ago. Thanks again

[@MiriamAndrade-w1p]

Thank you for posting this informative and interesting video!

[@dradamrosen]

Glad you enjoyed it!

[@cpp263]

very informative I am facing surgery soon and you have helped me narrow the issues I will discuss with my surgeon.

[@dradamrosen]

Glad it was helpful

[@dsa4931]

Well said..... Approach is not everything .....😊

[@dradamrosen]

Couldn't agree more.

[@SaltyKayak]

I will be heading to the table in a few months for a right hip replacement. One question I have and not seen an answer to, is the anterior vs posterior operation better or worse for when you have to go to the toilet?

[@PetPrepRadioShow]

@Dr Adam Rosen -Knee Pain & Arthritis Information Shalom! Thank you DOC for your info! I'm seeing a surgeon this morning to discuss the anterior approach. I got a lot out of your video! My goal is to return to riding/training horses again. I'm very curious which type of material you recommend for the replacement as I need both hips done and not crazy about plastic. I'm severely arthritic. Originally, I was scheduled to have surgery, posterior approach on the 24th of this month, but I didn't have enough info or feel comfortable enough to move forward. After watching your video, maybe the posterior approach is best, after hearing your thoughts about tendons, muscles; mine are most likely torn and spasming; and repair would mean relief! Severe Chronic Pain is NO fun! I hope you will answer my comment as I'm anxious to make a decision to schedule surgery! Thank you AGAIN! Shalom!

[@dradamrosen]

99% of total hips around the world have a bearing of a ceramic head with a plastic (cross linked polyetheylene) bearing. Thats what I would have if I were having a hip replacement. Ceramic on ceramic is an option but has a very small risk of fracture (which could be catastrophic) but it also has a 10% risk of audible squeaking which many patients dislike.

[@TimFitzhenry]

Good info, I recently had a broken hip replaced that the cement fell apart and was infected. In replacing that they put in a temp with an antibiotic block in it which then was replaced in 6 weeks with the permanent one. Now it dislocated once and attempts to dislocate again. Did the number of replacements weaken the socket ?

[@dradamrosen]

It probably is not a weakening of the socket but due to the inadequate soft tissues after an infection and multiple surgeries. The quoted number for a dislocation after a routine total hip hovers around 2% but for each surgery after that, and it sounds like you had two, the dislocation rate climbs. Sometimes a second opinion is a good idea to make sure there is nothing else wrong that could be contributing to an unstable hip.

[@roberttamurian4038]

Thank you for this review and I think it will help our patients. As a joint replacement specialist, who does both approaches I have found the literature supports the fact that there is more symptomatic extra bone formation, iliopsoas bursitis, tendonitis, greater troch bursitis/gluteus tendonitis and of course 40% of patients will have lateral femoral cutaneous nerve compromise after surgery with 11% that do not resolve by 5 years after surgery, all of which are much lower or avoided completely with a tissue sparing mini posterior approach. As such, after 25 years of orthopedic surgical practice, I have gone back to mini-posterior approach.

[@dradamrosen]

Glad you liked it. I personally had a low dislocation rate (

[@edgaracevedo9658]

I had a posterior approach hip replacement on 10/23/24. Today is day 7 pos-op and I'm doing very well. Prior to surgery I had pain on the side where the surgeon cut and the pain would run down to my knee cap. Once the surgery was over, the knee cap pain went away. By the way, I weight 320 pounds, my BMI 51 and so I was turned down by many surgeons for 5 years. This surgeon had experience operating on overweight patients and he mentioned the posterior approach was the way to go for overweight individuals.