Basic Introduction

Daniel Farrel, MD

Less tissue damage during surgery combined with state of the art anesthetic and pain management techniques allows for patients to have a much more rapid recovery than traditional methods of hip replacement. Patients go home in 1-2 days and transitional care unit or nursing home stays are basically unheard of with this technique.

Why SuperPATH?

The goal of any hip replacement is the best long term result combined with the fastest recovery to normal. The SuperPATH technique is arguably the least invasive hip replacement technique. Less tissue damage during surgery allows for a much faster recovery and no restrictions after surgery. It allows for all of the benefits of a minimally invasive surgery without some of the downsides of other techniques. Some minimally invasive hip techniques have actually shown MORE muscle damage than the standard approach. By working inside of the bone without cutting any tendons, this damage is truly kept to a minimum. An x-ray taken during the procedure confirms that the implants have been inserted correctly. Poorly aligned implants have been the downfall of some other minimally invasive techniques. For surgeons performing the technique, there are no restrictions on which patients can have it. No special table or devices are needed. The procedure is safe and reproducible. Also, for the rare times that there may be difficulties in surgery, it can be converted to the standard procedure in 2 minutes with ease. As for the long term results, we do not have 10-20 year data on the SuperPATH technique because it hasn't been around that long. But we do know that by subscribing to well established critical principles in regard to the longevity of hip replacements while at the same time offering the patient the fastest recovery available, we can make their hip replacement experience one of highest quality and value.

Advantages of SuperPATH

  • Faster recovery (usually close to normal activities in 3-4 weeks, sometimes faster)
  • Less pain due to less tissue damage
  • Absolutely no restrictions after surgery
  • The hip is never placed in potentially unsafe, twisted positions
  • Quicker hospital discharge (1-2 days)
  • Rare nursing home or rehab center stays, even for the elderly patients
  • More natural feeling hip

SuperPATH Surgical Steps

The patient is laid on the side with the arthritic hip in the "up" position. A 3-4-inch incision is made above the tip of the bone you can feel on the side of the hip. The buttock muscles and tendons are spread apart without cutting any of them off of the hip bone which exposes the top of the hip. This is why some have termed this the "Northern Approach." The joint capsule (sack around the ball and socket) is then cut over the top of the ball and neck of the hip. Placing the capsular incision here has the advantage of not weakening the joint support to help avoid dislocations while also allowing the entire capsule to be preserved. In other approaches (especially the "Anterior Approach") the capsule is partially removed. The edge of the socket, top of the ball and neck of the hip are now exposed.

The next step is where the procedure gets the nickname "The Ship in a Bottle" technique. A trough is then cut into the bone of the ball and the neck to gain entry into the thigh bone. Through this trough, the thigh bone is prepared for the lower part of the hip prosthesis. This is known as the femoral component. The ball is then cut off through the neck using a special saw designed for safety. This decreases the odds of tissue damage as well as decreasing blood loss. The ball is then pulled straight up out of the socket having never been dislocated. Attention is then drawn to the hip socket.

A special guide designed by Dr. Penenberg is then used to position a half inch incision just behind the thigh bone and below the first incision. Through this guide, a PATH is made and a small metal tube is placed into the hip socket. This tube is the pathway for instruments to help prepare the socket when used in conjunction with the first incision. The socket is prepared for an outer metal shell into which we can place a plastic, ceramic, or metal liner depending on the type of bearing, or joint surface we want the hip to have. We are developing constantly improved ways to further the abilities of this approach for even difficult revision (re-do) hip procedures.

Once the femoral and socket components are in place, a semi-custom neck and ball combination is selected and implanted allowing for the most stable hip possible with recreation of the patient's anatomy to normal most all of the time.

The joint capsule is closed as are the other layers of tissue that were opened. A drain is placed into the deep tissues of the hip to help decrease swelling. Sterile dressings are applied and then the patient is taken to the recovery room.