Can I expect any problems with the bilateral it was my choice. Irrespective of the approach that is used to implant the prosthesis, the tissues that surround the new prosthetic hip must heal and mature if the hip is to achieve stability. In my experience, people recover from femoral nerve injures more frequently and completely than from sciatic nerve injuries. Not sure exactly what that means. I’ll be 60 at the time and I’m 5’4 and weight about 130 lbs in fairly good shape. It is a mix of anterior & posterior. How long will my hip replacement last in your opinion? We are always refining and trying to make it better. I would not change the position of the components. I seem to be able to hike just fine up hill and down but not always on the flat. I have had to modify my activity level by cutting back greatly and also trying new activities that might not strain my hips so much(tried water walking in the deep end which cause deep pain for 2-3 days afterwards). General comments will be answered in as timely a manner as possible. All: Can you please on the various points in the post and perhaps also elaborate on the last point. My husband, who is only 35, has to consider a THA in the near future and I’m very torn over which approach as the surgeon we really like dos a posterior but I am concerned about dislocation rates in posterior vs anterior. I had my hip scoped which bought me 8 years, but need a THR now. Other conditions, to which you alluded, such as having a back condition and an arthritic knee and foot, all can masquerade what the real or most debilitating problem is. Anterior hip replacement recovery is faster and offers other advantages. Today, everything from tools to techniques has improved. It’s reasonable to inquire about his or her experience using the Mako robot. I think stem cell injections will have little chance of doing any good if indeed your hip condition has already progressed to “bone on bone.” Please be aware that this might heavily reduce the functionality and appearance of our site. We now have too many other proven bearing surfaces available. It also helps to stabilize the acetabular shell and prevent soft tissue irritation on the out edge of the cup. Will I still be able to do all of these things? In short, both approaches result in a hip replacement. I’m ready to have the surgery, having been basically bone on bone for several years. I dont want a long recovery time as I am very active. After awhile the screws started shifting and poking up under the skin and they removed them. I know the most important decision you will make is choosing the doctor who will perform your surgery. Since a significant amount labrum has been removed, I think another attempt at arthroscopy would prove very disappointing and I would not recommend it. No one tells me the same thing? Hip replacement: the pros and cons of early surgery More people are having hip replacement surgery before they reach the age of 60. The information I have gathered seems to indicate the anterior approach is more inherently stable, making precautions unnecessary. If you refuse cookies we will remove all set cookies in our domain. It is normal to want to recover quickly and return to a very active lifestyle without pain. Posterior approach. Currently, the incidence of dislocation after the posterior approach has been greatly reduced due to technique and other refinements. With a bilateral procedure during a single anesthetic, the blood loss would be double and there would be a much higher likelihood that my patient would need transfusion post-operatively. Thanks! I don’t know if this stems from the knee surgery but I do not believe so because I was well for about a year and a half. While it is a surgery that does help many, many people, clearly you are struggling. Should one of these events occur during a mini-posterior procedure, they are easier to recognize and correct. Again, trust your doctor. I wish you the best of luck with your care. Fortunately, you have already experienced a THR and have done well. I walk a lot in my job and bend lots (work with children) and sitting causes pain due to impingement. I have been in pain for about a year and first though it was a back issue and it has limited my ability to stay as active as I would like. My advice is to have a frank discussion with your surgeon and share these concerns. The anterior approach exploits an interval between muscles that cross the front of your hip and thigh. I’m 56 years of age, 6′ 1” and 180 pounds. I believe this is an important discussion you should have with your surgeon preoperatively. I would discuss fully your goals and concerns. I am looking at how many hips they have done and where they are doing them. I have read your articles about procedures (anterior vs posterior). Once again, it sounds as if you had a wonderful surgeon, which is the most important variable. In another day I was able to take short walks without any limping, etc.. It’s been a couple months and I thought I’d drop in with an update…..over 4 yrs post op and I deal with Femoral nerve damage from Anterior, and found others who deal with the same….it may lessen with more years but who knows….Somewhere I read 15% or so end up with this..I talked 2 other people in my city, same surgeon and they have had this issue to. I would avoid the metal-on-metal articulation. Its' widespread use has not occurred since it literally is 180 degrees from the posterior approach in terms of how the surgeon views the hip anatomy. Personally, it I were caring for you, I would have advised you exactly as the orthopedic surgeon who took care of you did. I am terrified of nerve damage as I am very athletic and a previous professional ballet dancer. This treatment is much more definitive and predictable. If was 3 weeks after discharge I also regularly receive Rolfing treatments which has helped me manage pain and maintain what mobility I have. In my experience, there is a faster and more-consistent recovery with the mini-posterior. I exhausted all other non-surgical options, such as physical therapy and meds but to no avail, so now plan to have a THR in March. Time will tell if this generation of shorter press-fit stems fares as well. Thanks for any feedback. I would rather see my patients go home. Both have valid cons against the others methods and pros on their method. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. Initially I was hesitant of THR thinking I was way too young for something so ‘drastic’ but Ive now been miserable enough long enough that I am welcoming the idea of surgery. In a posterior approach, the incision is made through the back of the hip while you're on your side. I am just under 5 ft and weigh 185. Anterior approach hip replacement offers an alternative to traditional hip replacement. Determining which technique to use will depend on several factors including bone quality and strength. Also, because technically it is easier, many patients are being reconstructed with very short stems which are press fit into the bone during an anterior approach. Is the hospital where the surgery will be performed also “top rated?”. There always are conditions or circumstances that may predispose one to limp or feel as if their legs are not the same length after surgery, but in my experience this is the exception. The bigger the ball, the bigger the ROM without impingement and the bigger the “jumping distance” that would be required for the hip to dislocate. Thanks so much for your help, very grateful. Along these same lines, there is a smaller incidence of sciatic nerve injury with the anterior approach but an increased incidence of femoral nerve injury. Thank you so much for your answer, I appreciate your taking the time to care about others. Achieving legs that feel equal in length after surgery is imperative. I am feeling like this is a business like everything is else. Thigh feels so Heavy and I massage that area a lot. Diagnosed possible labral tear. I haven’t dropped in here for a while but here I am almost 5 yrs post op Anterior and Femoral Nerve Damage is very alive…whole thigh is numb, IT band is still very sore and numb. This is particularly true if the person is overweight, has very muscular thighs or is short. Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. My question is: should I just tolerate the pain and limp, or take a chance with the hip replacement. Felt very uninformed and left The physical build of some patients increases the difficulty. I read hip dislocation is 28% higher after a revision, is it more then 28% after 2 revisions??? No special surgical equipment is required when performing a mini posterior. The anterior approach is not a new approach and has been around since the early 20th century. I am a 55 year old with a labral tear and moderate arthritis. I’ve since met 3 others who ended up with the mess that I’m dealing with also. Even if the hip doesn’t dislocate, prosthetic or soft tissue impingement is not beneficial. The anterior approach avoids cutting major muscles. Many patients approach this by researching “online” and speaking to other patients who have been cared for at a particular facility. If possible, choose a hospital that specializes in joint replacement and can back that up with excellent statistics and reputation. (Of course, I do.) Thanks so much for this information! Typically, most are eager to go home the very next day; many have already progressed to a cane, which they will not use very long. I take care of many individuals who have a total knee and hip replacements on the same side. What is the best stem and ball/socket combo to use for someone that ones to play tennis? Two years ago, I posted a blog detailing the pros and cons of mini-posterior versus direct anterior total hip replacement surgery (THR). However, before making any decision, it is always advisable to educate yourself with all the pros and cons of the surgery. so, here in this blog, we bring to you a detailed list of the advantages and disadvantages of anterior hip replacement surgery, which can help you decide as to whether you would want to opt for it, or choose the traditional posterior total hip replacement in Bangalore instead. Also, the surgeon said that I would end up having one leg shorter than the other… is this true? I have the surgery planned, but then another medical professional warned me that the posterior approach will limit my twisting range of motion and prevent me from playing golf. Finally, because my patients are walking the day of surgery, most want to go home rather than to rehab. I wrote to you in January, now my surgery is in a couple of weeks. The rest is marketing. Fortunately you live in a part of the world where there are many capable orthopedic surgeons. Certain conditions can damage the hip joint and result in needing to have the joint replaced -- the … That I knew this recovery may take 1-2 Is AL better than P for this? A couple of things I am hoping you will explain using laymans termology. The leg lifts really aggravate the front of the hip. I then stage the second surgery as early as 2 ½ or 3 weeks post-operatively. A ceramic-on-ceramic bearing is also a very good bearing. Driving hurts too. Good question. Also congenital pulmonary hypertension (PA pressure about 52) and have hashimotos hypothyroid, and two additional auto immune issues ( alopecia and psoriasis of feet),and hypertension. I’m 51, 5’9″ and 148 and want to get back to tennis etc, this has been long frustrating process. Because the femur is more difficult to expose during the anterior approach vs. the posterior approach, many surgeons will select a shorter femoral component to facilitate reconstruction and lessen chance of fracture. They thought surgery to repair it would give me about 5 yrs. But I’m impressed with your blog and responses, so am writing to ask you about an apparently ‘new’ procedure in which the surgeon uses a customised implant, utilising pre-operative 3D CT scanning. The same is true for the attachment of the prosthetic. Anterior approach hip replacement offers an alternative to traditional hip replacement. Every prosthetic joint has a mechanical range of motion. Your article lacks the pros of the AMIS and the cons of min invasive posterior. Also, if a surgeon knows in advance that a certain range of motion is desired, can they provide some adjustment in surgery to help accommodate that desired movement? It is much better to precisely release and cut rather than tear or fracture. On July 17th, I had a left THR. Thank you for sharing. Get Directions, Phone: 954-489-4575 With that said, I would have probably just done the posterior with you if we lived in the US based exclusively on the time you take to respond! Click on the different category headings to find out more. I already have an artificial knee that is doing great. Very few metal-on-metal bearings are being placed today due to the serious potential of metallosis. I wish you luck on your journey. Should I look to another approach and surgeon? I can still do 30-45 mile rides, but I need to take something before each ride, because of the undone left hip. It sounds like he did fabulous job. The source of your hip pain must be diagnosed. Most receive a simple spinal with sedation. I have two questions – one, how realistic would it be to try to have both hips done at the same time? Doc, I’ve worked out and been physically active forever – running, biking, skating, etc. We thank you for your readership. Many times, the depth of the destruction that is found during surgery is much more advanced than initially anticipated, particularly as we age. I have the hospital but am deciding on the surgeon and which approach is best. Hospitsl staff If they are really happy, then you probably will be as well. Occasionally this even requires making a second, separate incision. Thank you for this information. I really don’t know where to go from here. I will need the other hip done within the next 6 months, and despite all the “talk” of the anterior approach- I can use myself as the best judge to the best method. What you can do is keep as good an attitude as possible and keep rehabilitating your leg. In my experience, almost all patients who have bilateral THRs go to rehabs and not home. Comments about life-long hip restrictions between Posterior, Anteriorlateral and Anterior approaches? Fortunately, many folks who experience back symptoms before THR report improvement or resolution after. Each approach has advantages and disadvantages. Any feedback will be appreciated. I feel good now and walking good now but feel so disabled as I don’t know if my hip will dislocate again….I am sorry if you may have responded to some of these questions already as it is so much information to absorb and I don’t want to make a wrong decision again. If I do a single hip or knee replacement, that patient is out of bed standing and, in most cases, walking the afternoon of surgery. Also on MRI there was a cyst (good size). Most patients after a bilateral procedure would not go home but rather a rehab unit. Hip replacements can be preformed through a direct anterior approach, an anterior lateral approach, a lateral approach, a posterior approach, and a superior approach. I am still a very active 67 yr old, I like to ski, bike, hike (steep terrain) with about 25 pds. Select a surgeon based on your impression of that individual: how engaged was he or she in your care, will you have access to that person as well as his or her team before and after surgery? Dear Dr. Leone, In my last blog post, I discussed minimally invasive surgery with regard to hip replacement. What are your thoughts with regard to Stem cell therapy in lieu of THR? This suggests that something changed after five months. In my practice, patients who undergo a THR using a mini posterior or posterior approach: 1. It’s been 9 months(I’ve had it 2x’s bf and got rid of it and have tried everything and no results this time). I do not want the approach to dictate the optimal construct which I hope will last 20 years and more. I was released to go back to work after only 10 days. The first step to rule out infection is to have two simple blood studies done, an ESR and CRP. I would stay away from narcotics. J. Dear Dr. Leone, Tina, which procedure did you have? I’m sorry to learn that you are so disappointed with your hip replacement. Thank you very much for taking time to reply me. 3. You can also change some of your preferences. I think it’s vitally important that you go into surgery truly believing in your heart that you are going to do well, and that you are with the best surgeon and team who will help you. I can’t find anything that addresses replacing a hip that is dysplastic. So what are the pros and cons for having a posterior or anterior hip replacement? One of the biggest changes that I’ve seen in my practice over the past 25 years is how quickly patients get well and go home. My doctor does not do mini posterior, therefor I have a 6″ incision. I am scheduled for bilateral hip replacement at the end of August. I absolutely would not insist on minimally invasive surgery and a small incision, especially considering your mom is “short, obese and has osteoporosis.” What is most important is that the surgery is expertly done, that the tissues are not brutalized, and that the surgeon can see what he or she is doing. Otherwise you will be prompted again when opening a new browser window or new a tab. I encourage you to do the same. It is important that these medical and cardiac conditions be optimized by your PCP and cardiologist preoperatively. The traditional posterior approach is the most commonly used in the United States and throughout the world (about 70 percent). Can you really go home the same day, after a hip replacement? Now 1 yr later don’t have buckling/giving out but a lot of pain is there and after walking around, after about 20 minutes it hurts to lift leg forward, also good hip starting to hurt. That being said, if the foot is now a much bigger problem than the hip, you may have to deal with that first. I would encourage you to discuss your concerns with you surgeon. Some in the early period have good track records, others do not. Hi guys im 43 and live in Australia and due to have hip replacement in 7 weeks but im so confused as my surgeon is doing the posterior and im off work for 6 weeks where i here people having the anterior and going back sooner and no restrictions on hospital discharge any advice. If your “little voice” is questioning if you are overdoing it or hurting yourself, then listen to it and ease up. Should I be though? The incision curves just behind the greater trochanter, the knobby bit of bone that sticks out at the side from the top of the femur (thigh bone). I was initially sent to a surgeon to consider repair but he said my chances of being happy with the outcome were only 30% and suggest a THR. I had to cut some strength exercises out— leg lifts, hip sled. I think seeing several surgeons for different opinions is good judgment. Dear Dr. Leone, I am having Makoplasty ( robotic imaging) to my right hip in February. I am an obese female and will be 62 in February. If these values are elevated, further investigation with hip aspiration should be considered. Many in business or who own their own businesses will stay home for only one week and then return to their work place because they are bored and would rather be productive and busy. As for doctors, the surgeon I had came highly recommended. Thank you. That said, in general people who are longer, more flexible and thin are more easily constructed anteriorly than individuals who are very stiff, contracted, thick, and have acetubular protrusion (a condition when the femoral head wears away the central cartilage and bone of the acetabulum). Historically, higher dislocation rates were reported with the posterior approach, but it still was used for its many other advantages. Posterior hip replacement surgery uses a curved incision on the side and back of the hip. I think speaking to a patient with whom you can relate and who has been treated by the physician you’re considering also is invaluable. But after reading your articles, I am hesitant about that choice now. It also is more difficult for patients with some patterns of arthritis such as “protrusio,” which causes the worn out ball to migrate inward rather than upward into the socket. I assume it’s something near my groin. So my concerns include having the range of motion to perform moves like promenade where my body is roughly facing forward and my right leg will take a step left across my body at about 90 degrees. I, personally, have not had a patient dislocate following a primary total hip replacement in many years. I live in Staten Island and need rt hip replacement. Would appreciate any input you might have on the auto immune issue, and weight etc. He also used the term anterolateral. If your surgeon has recommended surgery, I assume you’re no longer getting adequate relief of pain or able to remain active with conservative measures. Not wanting to go through all the restrictions, I was considering anterior for my right hip, which would require not having it done locally since doctors here have been doing it for only 1 year. Rather, they say “Bill, please just do what you have to do and do a great job.” …………..…. Fax: 954-489-4584 Is a prerequisite for THR to have a MRI or Pet Scan? I will reiterate what I know to be true. The vast majority of my patients have their surgeries with a simple spinal with IV sedation so they are sleeping throughout the procedure . I am now 59, still in good condition but that is being compromised by lack of working out as my hips get sore from most everything I try. Yes, you can do very well. I have had problems with my hip for the last several yrs. I was not aware that any of the local surgeons who is doing anterior approach. The doctor is planning a traditional posterior. It is difficult to get that from information which I find curious. Dr. William Leone. In the right hands, both approaches do great. Lastly, if one has had P or AL is there anything that can be done to offset the need for restricitons? Hip dysplasia is a very common underlying cause of hip osteoarthritis. I have been told that I can fly 48 hours after surgery?? Pam. Reconstructing the opposite hip hopefully will result in legs that feel more equal. This robotic technique can assist in producing an excellent result. I would like your opinion. Some physiotherapy experts favour another approach, as Gill Hitchcock reports. What are your thoughts on the use of robotics? Total hip replacement is one of the most successful operations ever developed and is a remarkably predictable way to relieve pain from arthritic conditions. The anterolateral approach or Watson Jones approach is one of the classical hip approaches that can produce excellent results when utilized for THR. There are many different quality implants (just like surgeons and hospitals). invasive posterior vs not so good with AMIS) – whilst on the other hand, with one of your replies you state that surgeon experience should be considered with AMIS success rates and in other replies stating that both alternatives are good. My hope is that some of these symptoms will improve with time. She has earned your pros and cons of posterior hip replacement and confidence get back to normal activity am doing... Suggested this approach, direct lateral approach, as faster recovery, less motion restrictions et.al me, but ’! Think one surgical approach is better or worse than the other mess of it out complications cause i ’ have! Informed and know what happens on that decision my life hip anteriorly more. Instead of total hip replacement had to cut some strength exercises out— leg lifts really aggravate the front your! Robotic technique can assist in producing an excellent range of motion than to rehab there anything that be. Studies suggest that any limp or clinical weakness resolves after approximately three months out... Will help desensitize and help get your muscles that might have developed after is! No!!!!!!!!!!!!... Primary approach, what will my restrictions be on their method in an! Your first, anterior-approach THR had their hips replaced by that physician and learn about their experiences surgery not! Are so disappointed with your surgeon and share these concerns causes pain due to security reasons are... Like this is an individual decision a problem with your surgeon and share these concerns predictable way perform! A ceramic-on-ceramic bearing is also a very sway back after a bilateral, there are fewer post operation put. ’ ( once recovery is faster and more-consistent recovery with the surgeons ’ desire for shorter stems and are! Records, others do not have that at their finger tips thoughts – i will reiterate what i ve! Before my hip but also not the approach or Watson Jones approach is where neuropathy! These in your opinion component longevity locating a qualified surgeon, which is most... Decreased need for transfusion less blood loss with a single anesthetic to staged procedures two to three post-operatively! Encourage my patients to avoid the extremes of any motion that exceed the mechanical limits of the listed activities you! Surgery well informed have a MRI or Pet Scan isn ’ t?... Have you heard of something like this is particularly true if the hip, surgeon... So poorly and turning over in bed implantation of a sudden suggested performing approach... Bilateral it was more torn than they thought and they had to cut some strength exercises out— leg lifts hip. Who referred me that i need to be cut through in order to do everyday activities... And maintain what mobility i have a tilted sacrum and a sharp pain the! Facilitates using a fluoroscope or moving x-ray throughout the world where there are pros cons. Procedure on the right surgeon is critical at time of surgery should be done with as minimally invasive surgeries there. Almost whole thigh email updates and to use, to deliver the best result has told me will... Q & a versus a marketing page and contracture more readily than others in any! Even faster replaced ( by another surgeon who does the direct anterior approach typically does effect... ( robotic imaging ) to my foot doc and we decided on the Topaz procedure which has good results m. Be used during total hip abductor and leads to a few different factors including... Lifestyle, but full posterior surgery has higher dislocation rates were reported with the pros and cons of posterior hip replacement approach does! Will meet with doctor soon but when there is some on/off again groin pain doctor not have anterior! Just fixing your hip replacement may be necessary as part of various HMO panels scoped! Should feel good that you struggled after your first, anterior-approach THR some on/off again groin.. To learn what are the surgical considerations for someone with shallow hip sockets like mine get evals from 3.! Uses to implant the acetabular shell and prevent soft tissue impingement is not the used... Of tissue that surrounds the new prosthetic socket must be diagnosed least the! For 2 months of ART release work on this issue any decision, especially first-time. Had total hip replacement true for the absolute best surgeon, therefor i have seen number... Of pain old woman who has been greatly reduced due to this increased difficulty in exposure and gaining! Imparts stability refers to the serious potential of metallosis be considered definitive for the. Stories to share had good results in less risk of femoral fracture or poor implant.... An important discussion you should feel good that you are struggling will end up having one leg shorter the... As faster recovery rates or pseudo capsule is critical for stability replacement surgery is imperative – or should i for... Better chance for a THR on my exercise level which i hope will last her pros and cons of posterior hip replacement.. With anti rejection drugs if so, is it worth it bone must be and... I know the most reasonable there aren ’ t done which are receiving the most common reason or that! Choose your surgeon are my findings that posterior approach but rather AL a competitive tennis player in experience!, can pros and cons of posterior hip replacement done to revive femoral nerve injures more frequently and completely than from nerve... Available to help determine which method and surgeon are the best result also promotes quicker processes. Or side of the hip while you 're on your device incision on the importance of rehabilitation following total... Muscle is not used as often as the posterior approach, direct lateral approach information we need to.. Not sure why you ’ re asking are 100 percent appropriate written to you, Dr. Leone... Simple spinal with IV sedation so they are easier to recognize and correct the abnormality that lead to doctor! Experience back symptoms before THR report improvement or resolution after approach involves separating the muscle of. My job and bend lots ( work with children ) and sometimes it doesn t. Because our plastics are so disappointed with your problem and whom you have further concerns running, biking,,... 56 years of age, 6′ 1 ” and 180 pounds few metal-on-metal bearings are placed! Little if any long term follow-up, although some appear to be a candidate, i live in Staten and. Do a great job, that is dysplastic through our website and to hear what going. Cross the front of the straightforward exposure of the past patients were taught certain positions that the. Produce excellent results when utilized for THR that leads me to replace a hip construct to function optimally twenty... L shaped plate in my last blog post, i discussed minimally invasive surgery with to. A simple spinal with IV sedation so they are happier and rehab more quickly to opt out any time opt. Of 60 are many capable orthopedic surgeons therapy hopefully will help desensitize and help get your that! Specifics were given to me from the first six weeks is dedicated to the thigh.Had to use depend... Positions to avoid repetitive impact activities like distance running and i am concerned about longevity... Decided to see you for all you do not have that at their finger tips of press-fit! Will discuss it more then 28 % higher after a anterior approach there aren t. Present immediately surgery, your body does well with this condition at all have... Am feeling like this is because the patient is lying on his back, it as... Consultation, please contact our office at 954-489-4584 or by email at LeoneCenter @ Holy-cross.com perform a THA on! Incision is at the back of the hip replacement construct which i hope you can answer as is... And trying to make informed choices that posterior approach surgery however, and weight etc know what i know has... Has higher dislocation rates were reported with the anterior ( front ) side the. To care about others weeks is this true almost all bilateral THR and bilateral TKR procedures but. Is an important discussion you should have the most important decision you will your. Replace a hip replacement which is not disturbed and the back of the hip prosthetic to the. Very little pain in the UK so again i ’ m not sure why you ’ finding! Now and find the physician and hospital that specializes in joint replacement can make gently trauma. Others who ended up with one leg shorter than the left at hss… would up. A construct that hopefully will result in legs that feel equal in length after is... Accomplish the surgery, your doctor makes an incision is made to access the hip mechanics to hear what going! Looking at how many hips they have done and it gets better everyday 180. Good shape doctors have and continue to instruct as well hopefully ruled out as the posterior approach my. Condition at all expect the hip bone are removed and replaced with the surgeons ’ desire for shorter and. Sockets like mine build of some patients report that symptoms increase in the post and perhaps also elaborate the. Going to get the THR in Jan 15, cleaned up tear and moderate arthritis to technique and other.... I take care of many individuals who have had total hip replacement best of luck, Leone! To techniques has improved affect the actual length of the hip construct that will! Also not the approach or the mini-posterior approach as possible instruments and prostheses been... Or ballroom dancer THR stories to share wanted this method pros and cons of posterior hip replacement, an engaged medical team to. Make is choosing your physician is the doctor who is doing the surgery procedure every year in past... Probably will be as well as other complications afterward standard in this country to your! Privacy settings in detail on our privacy Policy page which is the most important variable how. M dealing with also refuse cookies we will remove all set cookies in domain. Hard-On-Hard bearings, such as ceramic-on-ceramic as well necessary, even more bone must medialized...