SuperPATH = Supercapsular Percutaneous-Assisted Total Hip
A SHORT HISTORY OF TOTAL HIP REPLACEMENT
Total Hip Replacement (aka Total Hip Arthroplasty) has been described as "The Operation of the Century," (The Lancet, 2007) in large part because it was so difficult to actually bring to life the difficult solution of replacing the complex moving parts of this major joint in the human body in a manner that was not only safe, but reproducible for surgeons the world over. Replacing a painful and debilitating hip joint truly gave patients back years of their life. Total hip replacement is one of the true triumphs of human achievement, in this century or any other.
Patients suffering from painful and debilitating hip arthritis knew no relief before the 1960s. Many attempts had been made to replace the painful joint and give patients back their ability to enjoy leisure pursuits, the ability to play with their grandchildren, or even just get on with activities of daily living. The progressive nature of the disease often meant decreasing mobility that eventually translated to confinement to a walking stick or wheelchair, and all too often a shortened life span because of the complications associated with prolonged recumbency. It wasn't until 1962 that Sir John Charnley, MD, of England published his results on the "Low Friction Arthroplasty" that the world learned of a means of removing a painful and diseased hip joint and replacing it with metal and plastic components that would for once and forever relieve the pain and infirmity of hip arthritis. It is only in the relatively short period of time from then until now that we have learned all we know about hip replacement surgery!
The SuperPATH hip replacement represents the culmination of all of the lessons learned through the decades of successful hip replacement surgeries, while minimizing recuperation and maximizing the benefits of postoperative rehabilitation for our patients. The SuperPATH hip replacement is the latest, minimally invasive means by which a surgeon trained in this specialized area of hip replacement surgery can remove a painful hip joint and replace it with a new and functional hip.
HOW DOES A SuperPATH HIP REPLACEMENT DIFFER FROM AN ANTERIOR HIP REPLACEMENT?
The human hip has been referred to as a "ball and cup" joint, in that the spherical femoral head rests inside the hollowed acetabular hip socket, an arrangement that imparts excellent stability while allowing for a multi-directional range of motion to the joint. A total hip replacement refers to removal of the femoral head and neck (the "ball" side of the joint) and the damaged lining of the acetabulum (the "cup" side). The means by which this may be accomplished gives rise to the names associated with different surgical techniques.
Both the SuperPATH hip replacement and the anterior approach to hip replacement are considered minimally invasive techniques. This means that they take pains to minimize the need for release of the tendons, muscles and ligaments that surround the hip joint and provide its stability. As a result, patients experience less in the way of postoperative "precautions" (limitations after surgery). An added benefit is that these patients experience less pain and have comparatively shorter rehabilitation periods following hip replacement compared to earlier surgical techniques that required greater releases of the tissues surrounding the hip joint.
The differences in the SuperPATH hip replacement and the anterior approach to hip replacement really have to do more with the direction of the surgical approach to the hip joint, and to some degree the position of the patient during the surgery. As one might expect, the anterior approach to hip replacement means that the surgeon approaches the joint from the front (anterior) in order to reach the moving parts of the joint and facilitate replacement. The patient is typically positioned on their back throughout the procedure, and the scar to the hip will be found in the front area of the hip. With the newer SuperPATH hip replacement, the patient is positioned on their side (the more traditional position for hip replacement), giving the surgeon a more traditional orientation to approach the hip joint. The surgical scar for the SuperPATH hip replacement is thus located on the back area of the hip.
WHAT MANNER OF TOTAL HIP REPLACEMENT WOULD THE SURGEON CHOOSE FOR THEMSELVES?
Both SuperPATH hip replacement and the anterior hip replacement are excellent surgeries, representing the very best in minimally invasive surgical technique. Both have plusses and minuses, both for the surgeon and the patient. Both have demonstrated excellent patient outcomes, low pain scores, short hospital stays associated with accelerated rehabilitation protocols and overall impressive results. Recovery following total hip replacement which only decades ago was measured in months has now been reduced significantly owing to these two fantastic means of major joint replacement.
The replacement components for the a hip joint are not affected whether a patient undergoes a SuperPATH hip replacement or an anterior approach to hip replacement. Smaller, minimally invasive implants have been developed for both surgical techniques, and both approaches have specially developed surgical tools to aid the surgeon in visualization as well as implantation of these replacement components.
A well done hip replacement, by any surgical technique, is still a good surgery. The most important advice for any prospective patient should be to seek out an excellent surgeon who is comfortable with hip replacement surgery using the technique that is familiar to them. Listen to the testimonials of the patients who have had a hip replacement using the SuperPATH hip replacement. Listen to those of the anterior hip patients as well. Educating yourself and tailoring your expectations will help you to feel more comfortable both about the type of hip replacement your decide to proceed with, and about the surgeon whom you trust on your voyage.
Both the SuperPATH hip replacement and the anterior approach for hip replacement have risks and benefits, both the patient and to the surgeon. The best type of hip replacement might simply be qualified as the one a given surgeon would select if he were undergoing the procedure himself. For me, that is the SuperPATH hip replacement.
C. Blair, DO, MBA
Fellowship Trained in Adult Hip and Knee Replacement Surgery
Texas Orthopedic Surgery Consultants
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