Hip Replacement Techniques

Surgeons perform total hip replacement surgery using various surgical approaches, taking into consideration their preferred surgical style as well as what will be the best surgical technique for their patient.  The SuperPath® approach and Anterior approach are two minimally-invasive options for total hip replacement, detailed below. Please consult with your surgeon should you have any questions or concerns about hip replacement surgical techniques.

What is SuperPath® Hip Replacement?

IncisionsThe surgical technique for a SuperPath® Hip Replacement was developed as an advancement to traditional total hip replacement. The SuperPath® technique is a tissue-sparing procedure which aims to get patients back on their feet within days (possibly hours) instead of weeks or months. A number of patients who have undergone this procedure are able to walk unassisted the day after surgery, and leave the hospital without the typical restrictions (such as crossing their legs) associated with total hip replacement.

SuperPath® hip replacement is a differentiated total hip technique being performed by a growing number of experienced surgeons.

With SuperPath®, there is no surgical dislocation of the hip. Patients can also have as little as a 3-inch incision. It is important to understand that “less invasive” does not only refer to the incision but also means less trauma to the muscles and tendons under the skin. A SuperPath® Hip Replacement is designed to precisely reconstruct the hip without cutting critical tendons and stretching or traumatizing muscles that are important to hip function.

Because of the elimination of damage to these important structures during reconstruction, patients typically have a short hospital stay and a number of patients walk the same day as their surgery.

Learn more about SuperPath® in the following videos:

 

What is the Anterior Approach for hip replacement?

Hip replacement surgery has been performed using the Anterior Approach for over 100 years, but has become more popular recently due to its development in minimally invasive surgery.  Compared to traditional surgical approaches, the minimally-invasive Direct Anterior Approach has a:

  1. Shorter length of stay in the hospital1-7
  2. More patients discharged home1,3,5,7
  3. Faster functional recovery2,4-6,8-11

One of the biggest advantages of the Direct Anterior Approach over traditional surgical approaches is the visualization during the surgery. This is because in the Direct Anterior Approach, unlike traditional surgical approaches, the incision is made in the front (anterior) of the hip joint between muscles allowing clear access for the procedure.

To access this interval, the patient lays flat on their back instead of on their side as in traditional surgical approaches. This orientation used in the Anterior Approach easily allows for x-rays to be used throughout the entire procedure, allowing the surgeon see what is happening during the surgery. The Anterior Approach has more accurate implant placement compared to traditional approaches, in large part due to intraoperative imaging11,12. Accurate placement of implants plays an important role in minimizing dislocations, and the Anterior Approach has a lower dislocation rate compared to traditional approaches8,13,14.

 

 

 

 

 

 

 

 

 

References

  1. Alecci V. Comparison of primary total hip replacements performed with a direct anterior versus the standard lateral approach: perioperative finding. J Orthop Traumatol. 2011; 12(3):123-9.
  2. Martin C. A comparison of hospital length of stay and short-term morbidity between the anterior and posterior approaches to total hip arthroplasty. J Arthroplasty. 2013; 28(5):849-54.
  3. Zawadsky M. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty. 2014; 29(6):1256-1260.
  4. Christensen C. Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty. 2015; 30(9):94-7.
  5. Connolly KP, Kamath AF. Direct anterior total hip arthroplasty: comparative outcomes and contemporary results. World J Orthop. 2016; 7(2):94-101.
  6. Goebel S. Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop. 2012; 36(3):491-8.
  7. Schweppe M. Does surgical approach in total hip arthroplasty affect rehabilitation, discharge disposition, and readmission rate? Surg Technol Int. 2013; 23:219-27.
  8. Mirza A. A mini-anterior approach to the hip for total joint replacement: optimizing results: improving hip joint replacement outcomes. Bone Joint J. 2014; 96B(11): 32-5.
  9. Barrett W. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013; 28(9): 1634-8.
  10. Rodriguez J. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res. 2014; 472(2): 455-63.
  11. Nakata K. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty. 2009; 24(5):698-704.
  12. Rathod P. Does fluoroscopy with anterior hip arthroplasty decrease acetabular cup variability compared with a nonguided posterior approach. Clin Orthop Relat Res. 2014; 472(6):1877-85.
  13. Sheth, D, Cafri, G, Inacio, MC, Paxton, EW, Namba, RS. Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk. Clin Orthop Relat Res. 2015; 473:3401–3408.
  14. Tsukada S, Wakui M. Lower Dislocation Rate Following Total Hip Arthroplasty via Direct Anterior Approach than via Posterior Approach: Five-Year-Average Follow-Up Results.  Open Orthop J. 2015; 9:157-162.