Anterior Approach Experiences

[mslendzion]

My doctor performs the BHR using the anterior approach.  Has anyone had experience with this the anterior entry.   My surgery is in January.

[Dannywayoflife]

Hi mate welcome! Who is your dr? I'm no expert but I believe most of the top surgeons use the anterior approach 90% of the time. Of course they sometimes use others for various reasons so I hear. I'm sure pat or chuck will be along shortly to give you a little more detail.
You will find this site a great help with your journey! It's a great place for info and support.
Danny

[mslendzion]

Dr. Schmitt in Michigan.  How did your procedure go?  I hope you are doing well.

[obxpelican]

Actually it's the posterior approach that is used by most of the top hip surgeons.

Somewhere on Pat's site Dr. McMinn discusses the Anterolateral approach.  Dr. Mont uses this approach and so do several other doctors.  There have been some concerns where patients, especially larger patients do not respond well to the anterolateral approach because of the amount of retraction required.  Many patients end up with a permanent limp because of the trauma to soft tissue and nerves due to the heavy retraction.  Again, if you read the info here on Pat's site you'll find McMinn discussing this.

The big plus for the posterior approach is that it gives doctors a good exposure to the neck and to the acetabulum which allows for a better placement of the device.  When I was researching my surgery I got sold on the posterior.  Think of this, which is a bigger issue now?  Hip capsules or metal ions from misplaced devices?

The argument for the anterolateral approach is that it prevents dislocation, this has not been an issue for the posterior approach especially with the large MOM hip devices.  Another argument made for the anterolateral approach is that is saves the blood supply to the neck capsule, this has again not been an issue for the posterior approach.

You'll find Dr. Gross, McMinn and Dr. Su using the posterior approach along with many other hip resurfacing docs.

I am not a doctor, research research and more research, be the best possible patient advocate you can be for yourself.

Chuck

[Dannywayoflife]

Doh!!!! I ment posterior!! God that was a blond moment!
My op is in 7 days mate cannot wait to be in recovery!!

[obxpelican]

LOL

I call that a senior moment sometimes   



Chuck

[Dannywayoflife]

God I hope I'm not having senior moments at 28!:-)

[obxpelican]

At 52 sometimes I feel like I am 28, especially when I am on my jet skis doing 60 on the rivers near my house.  Never could have done that pre-op for sure.

It's not your age, it's how old you feel.   Now if only my shoulders felt the same as my operated hip  ;-)



Chuck

[Dannywayoflife]

Chuck your right mate it's just a number! The fittest toughest guy I've ever known is 50 and still going strong he's fighting for some kick boxing world title in the next few weeks!  Bless him!

[John C]

Hi mslendzion,
Just so that you do not get confused in your research, be sure as to whether you surgeon is doing a direct anterior approach, which it sounded like you are asking about; or the anterolateral approach, which is what Chuck replied about. Even though they are quite different, both approaches are sometimes referred to as "anterior". Each approach has its own pluses and minuses. You will find lots of info about the different approaches on this site if you look around.

John

[obxpelican]

LOL

Had I read his post at the end I would have seen the "anterior entry" part of his post.

Now either way you risk damage to a nerve that can cause a severe limp post-op.  Quote from Dr. Brooks

The true anterior approach can be associated with injury to a sensory nerve responsible for the side of the thigh (lateral femoral cutaneous nerve), and the location of the incision in the groin is not the cleanest part of the body.

Over 80% of surgeons in this country use the posterior approach, research before you let that doctor cut.


Chuck

[Woodstock Hippy]

I'll let you know how it goes. In 12 days I'm having bilaterals with Dr. Marwin.  He uses a direct lateral aproach with a anterior dislocation.  When I talked to him, he told me that 80% of the surgeons in the U.S. do posterior because that's what they learned.  He said that he learned posterior first and then anterior.  He said the direct lateral solved some of the problems with the operation giving better results.  He also said that he loves resurfacing because his pateints have such good results.  After my meeting with Dr. Marwin, I checked all over the web and found one article interviewing the top surgeons about their approach. Most had very good reasons why the did it their way, but they said that you should choose a surgeon based on his skill, not his approach.

[obxpelican]

Wood,

Yes, I've heard that a lot, pick a skilled surgeon not the approach, you just need to be aware of the pit falls of some of the approaches.

Keep us posted on your recovery for sure.


Chuck

[Pat Walter]

mslendzion

Hi and welcome to Hip Talk.  Not too many surgeons do hip resurfacing with the anterior approach because it is diffiuclt to get a clear view of the acetabulum with that approach.  That said, there are a few that do it sucessfully with the anterior approach.  Some use a special table while others don't.  Severl of the more know surgeons are Dr. Matta in CA and Dr. Kreuzer in TX.  I have heard a handful of patient stores recently from Dr. Schmitt and not heard anything bad.

The point most discussed at the hip resurfacing courses is for the surgeons to use the approach they are most comfortable with, learned with and have the best outcomes with.  Again, most use the posterior approach and use it very sucessfully while a small number use other approaches sucessfully.  Even when the surgeons use the same approach - none do the surgery in the same way.  They make presentations about their surgical approaches and even laugh how each surgeon does it their own way even with doing the same approach.

Most importantly, stick with a surgeon that does a large amount of resurfacings with their approach and you will have the best odds of having a great outcome.  Surgoens need to do a lot of resurfacings to keep on top of their game, a few now and then allows them to get "rusty" with their techniques according to the information I have learned at the hip resurfacing courses.  Hip Resurfacing is a diffiuclt surgery, but the top surgeons do them a lot and stay in the groove, they don't have to stop to think about how to do something - it is second nature to the top surgeons.  Like a really experienced quarterback - they have an instinct of what to do without thinking about it.

Good Luck.

Pat

[curt]

Its good to get differing perspectives from patients, and also to get a feel for outcomes.  Even though the majority do posterior, most can explain why they do it the way they do.  Dr. Gross liked posterior because he felt that he could reproduce good placement easier that way.  Others may prefer one of the other methods (Anterolateral, Direct lateral, Sliding Transtrochanteric, and Direct Anterior).  I don't know enough detail on the other methods, but can say that my doctor's description of his method and why he chose it swayed me all the way.
I would keep others' opinions in mind, and get all the information that you can, but lets face it, if you have chosen an experienced doctor, with a good track record of results (which he can and should provide), then what works for him will probably work well for you and that's the main goal, right?  Best of luck however you are guided.  Curt

[Woodstock Hippy]

I' only three days out with Bilaterals, so I'm hardily an expert but right now all I can say is
"right On!". I'll keep posting here as this progresses but right one it all feels great.

[Woodstock Hippy]

Where is your wound and and how long is it for Anterior.  Mine are about 10 inches long directly down the outside of my hips.  Dr Marwin calls this a direct lateral approach with a anterior dislocation. PT doctor today said that an anterior typically is like a J cur in the groin, like someone posted above.  How is yours?

[mslendzion]

Hi, I was advised my incision would be made in the front of my leg down the middle.  I received feedback from another hippy who used the same surgeon and said the incision was about 7 inches long.

[PistolPete]

My Surgeon does a lot of HR surgeries using the Anterior approach.  My surgery was originally going to be done with the Anterior approach but at the last minute he decided to go Posterior because he felt with my Martial Arts Posterior would be the way to go in the long run.  He did say that recovery is MUCH faster in the Anterior approach because there are no muscles being cut but the surgery is much more demanding on the surgeon.  I told him to do whichever was easier for him and better in the longrun for me.  If he went with the Anterior approach I would have about a 3" incision vs. the 8" incision I'm currently sporting.

[Anniee]

Woodstock, that's funny - my incisions are on the side of my hips too and are 4".  Dr. Gross calls this the posterior approach!