Anterior, Lateral or Posterior resurfacing or THR Approaches?

[sfinrecovery]

Hi, there,

I need help.  In speaking with doctors and looking at surgery approaches I see that there are opposite views on each of the surgical approaches, anterior, laterla or posterior.  This applies to resurfacing as well as THR.  My doctor has indicated that he may go in for a resurfacing, however, may end up as a THR - if this is the case, I want to make sure he/she uses the LEAST invasive entry that will allow me better/ faster recovery.  I have found these approaches on another web-site: posterior (being the most widely used and easier for the surgeon); mini-incision hip replacement; antero-lateral; anterior; and two incision approaches, indicating that the posterior approach is the best. 

Yet, another web-site indicates that it is the anterior approach that has the least disadvantages, being the one that allows for quicker recovery.

I know there is never the "right" answer, but... how can I make an educated decision?  Are there any new articles, studies, statistics or personal experiences you all can share?

Any help will be appreciated!  J.
 

[resurface]

J -

I can only speak from my personal experience, my surgeon (Dr. Snyder at Newton Wellsley) used an anterior-lateral (more lateral than anterior).  I understand that it requires less dissection as opposed to going through the glutes.  I also understand that, initially, there is less chance of a dislocation.  Seems accurate as Dr. Snyder had post op instructions with no limitations.  I also had no issues sitting.  I am not sure if this is the same with teh posterior approach.  Others can help with that.  Personally, I have a 4.25" incision.  My recovery was exceptionally fast.  At 4 1/2 months I just fininshed cycling up Mt. Lemmon in Tucson, Az.  That said, I was in very good shape prior to surgery. Was the recovery due to my conditioning prior to surgery or the entry point???  In all liklihood it was a little of both.  For me, and I hope never to do this again, I prefer the anterior-lateral. 

[Lopsided]

... uses the LEAST invasive entry that will allow me better/ faster recovery.

I am not sure that the smallest incision means the better recovery.

[Dayton96]

Juan:

There is a lot of information here and on the Yahoo group's resurfacing site concerning the different approaches.  The vast majority of the more experienced surgeons, such as Dr. Gross, Dr. Su, Dr. De Smet, and Dr. McMinn, use the posterior approach.  It is a little more difficult for the surgeon, but they seem to think there are benefits to it.  I encourage you in particular to watch the audio interviews that Pat Walters and Vicky Marlow have done with all these doctors.  The interview questions included a discussion as to why they used the posterior approach.  I've read that, while the antero lateral approach is easier for the surgeon, there have been some problems with permanent muscle weakness, permanent limps, etc.  Also, as far as scars, etc., I'm a little less concerned about that.  I want the surgeon make as large an incision as he needs to get the job done right.

Good luck on your research.

Mac

[resurface]

Mac -

Can you provide some references for all the assertions that you made about the anterior approach?  My understanding is just the opposite: it is more difficult for the surgeon, there is less tissue disruption, etc.  Never heard of a permanent limp, muscle weakness, etc associated with this approach. 

Thanks...

[Pat Walter]

The most important factor in having a resurfacing or THR is to choose the most experienced surgeon.  A surgeon that has done thousands, not just a few hunded.  The surgeons each use the approach they are more comfortable with.  In general all of the very expeirnced surgeons on my list use the posterior approach.  When done in the hands of the experinced surgeons, a patient can have a very quick recovery regardless of the size of the incision.  I am proof of that having used Dr. De Smet along with thousands of his patients.  Here are responses from the top surgeons about the approaches and why they use generally the posterior approach  http://www.surfacehippy.info/faqsurgicalapproach.php  You can also view many of the surgeon videos I have done and they explain what approach they use  http://www.surfacehippy.info/shvideos/videosdoctor.php

Personally, I would not choose an approach to choose a surgeon.  I would choose the most experinced surgeon and let them decide on the approach and device.  Resurfacing is very diffiuclt and very technical.  There is a small difference between the approved devices and only a really expiernced surgeon can decide what is best for you.  Several of the top surgeons use different devices for that reason.

Pat

[Dayton96]

Hi Resurface,

Good to hear from you again.  I've enjoyed reading your posts since last Spring.  You probably don't remember, but you answered one of my posts on whether or not there was one particular device that would work best for runners, as well as a particular approach, such as such as posterior or anterior.  At the time I was still in a little bit of shock about having to have a resurface and I was afraid I might never run again.

That started me reading everything I could find on devices, surgeons, approaches, etc.  I emailed back and forth with Pat Walters and Vicky Marlow (among others). The best advice out there seemed to collectively say (with a few notable exceptions) to go with the BHR, posterior approach, gluteus maximus tendon reattached, and the most experienced surgeon with the lowest infection and revision rates. 

I paid particular attention to the issue of posterior vs. antero lateral approach, because there is a surgeon close to me that met all my criteria (and he was covered by my insurance to boot) but used the antero lateral approach.  I tried to discuss my concerns with his PA, but I could not get a straight answer on how many of that particular surgeon's patients ended up with a limp.  He kept saying that most patients had some type of limp after surgery, but that it eventually went away for most patients.  When I asked how many patients had the limp remain, he seemed to me to get a little evasive.  After a similar conversation with another surgeon's office, I decided to concentrate on surgeons who used the posterior approach.

Once again, I encourage anyone who is interested in hearing more on the subject of anterior vs. posterior approaches to a hip resurface, to watch the videos Pat referenced above, or to read the transcripts.

Sorry Resurface.  Not the hard data you are asking for, just my opinion.

By the way, in that post you sent me last Spring, you recommended that I take care of my knee before I had my hip resurfaced.  I replied that the MRI was negative on my knee.  Well, come to find out, the knee specialist misread the MRI and x-rays.  I do have some cartilage damage in my knee.  The surgeon completely missed it.  So now I have a hip resurface scheduled for Dec 8 and I'm scrambling to find a new doc to look at my knee and tell me what can be done and if I should cancel the hip resurface and take care of the knee first.

Does anyone out there know a good knee doc in Cincy?

Mac