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.

[ReneeP]

I believe the surgeon uses whatever approach he/she feels most comfortable with.  If there is a specific approach you want, you would have to find a surgeon who uses that approach.  I am having right BHR in November and my surgeon (Dr. John Keggi) uses the direct anterior approach.  It's supposed to be less invasive and a quicker recovery, but more challenging for the surgeon.  However, he and his uncle (Dr. Kris Keggi) were instrumental in developing that approach and have perfected it over the years.  It's the only approach they use for THRs and they are now using it for resurfacing.

[pc]

Personal opinion is that the main issue is proper placement of resurfacing. If that means a 7 inch, or 8 inch ,or even a 12 inch cut I wouldn't really care too much. My surgeon cut well over 10 inches and got everything in the perfect place. I am almost 3 weeks post op and I couldn't be more satisfied or thrilled with the results. Recover is depended on the work you do prior to surgery to get as strong as possible and going in with a good attitude. The muscles will heal regardless of the approach. I just wouldn't get hung up on whether it is anterior or posterior. Your bones won't heal any faster, you will be approaching recovery the same. Make sure the surgeons have a lot of experience and a good record. My guess is at 6 months post op it won't matter what approach was used as long as the quality of surgery is equal. The way I look at it, the bigger the hole the easier it is to get everything in the right place. But, if someone can do it with less of an opening there is nothing wrong with that either. Best of luck Rick

[gary2010]

Juan,
If you have AVN but no osteoarthritis, then you need a surgery which preserves the neck capsule, this requires a posterior approach. I would read carefully the writings of Dr Vijay Bose on the subject, on this site and elsewhere, many of his patients have AVN. In advanced osteoarthritis the blood supply becomes intra-osseous rather than external, so it's less important.

I would also discuss with your surgeon the circumstances under which he would perform THR; all surgeons have to say this to cover themselves, I made it clear I didn't want replacement unless it was mandatory. I was even told under spinal anaesthetic I could be woken mid-op to discuss it!

I wouldn't worry about the size of the incision either, there is a trade off between the size of the cut and the amount of retraction used. The very small incisions are used only by those surgeons with thousands of cases behind them.

Good luck, G