The SuperPATH refers to the superior percutaneously assisted total hip replacement technique. First developed over 15 years ago, this technique is now gaining traction as a less invasive and safer approach to hip replacement allowing rapid recovery for all patients.
A recent article published by the Journal of Bone and Joint Surgery has demonstrated that the direct anterior hip replacement has more blood loss, a higher risk of intraoperative fractures, an overall higher complication rate and no difference in outcomes versus other techniques. While the direct anterior approach became very popular in the recent past for a purported faster recovery, subsequent outcome studies have not born this out and many surgeons are now moving away from this approach finding that it does not live up to the alleged benefits.
An ideal approach to total hip replacement should be one that satisfied several goals:
- maximum preservation of muscle, capsule and ligaments for early stability
- ability to use any type of hip implant geometry so the implant can be customized to the patient
- easy ability to assess leg length and stability on the table
- does not rely on intraoperative xray to determine implant position
- minimizes risk to surrounding nerves and blood vessels
- can be done in all patients
- keeps the incision in a clean area that is not prone to potential healing issues or infection
While the direct anterior approach satisfies some of these criteria, the SuperPATH satisfies all of them making it an ideal approach. The most compelling feature of this approach is that the entire operation can be done without having to dislocate the hip joint or position the leg in extreme degrees of rotation and non-physiologic positions as is required by the direct anterior and posterior approaches. Surgical dislocation of the hip stretches the surrounding soft tissues creating more surgical stress and injury response. The entire SuperPATH operation can be done with minimal manipulation of the lower extremity, reducing tissue trauma and surgical stress.
Preservation of the muscles and capsule around the hip joint provide more normal range of motion, greater stability and great joint position sense. This allows patients to progress their activities earlier after hip replacement without the potential risk of instability or dislocation. While the direct anterior approach alleges to be capsular sparing, in fact releases are necessary to gain exposure of the femur during this approach and these released tissues are not repaired at the end of the case. Cadaveric studies have shown that the amount of muscle and ligament damage is less after the SuperPATH approach than the direct anterior approach. Furthermore, at the conclusion of the case, the split in the superior capsule is repaired so that all structures are anatomically restored at the end of the case.
This approach fits very well into our AVATAR rapid recovery joint replacement program. We have found that a high percentage of patients can go home the same day as their surgery and avoid a hospital overnight with this technique. Please see our other blog posts about the AVATAR principles and technique.
For a comprehensive presentation on this technique, visit our YouTube Channel here: