SUPERPATH® is a relatively new technique used to replace the hip joint. For the past 25+ years surgeons have been improving techniques for hip replacements and as a result, Arizona surgeon, Dr. Jimmy Chow, has encountered this SUPERPATH® technique by combining two previous hip replacement techniques (Dr. Brad Penenberg’s SUPERCAP and Dr. Stephen Murphy’s PATH). SUPERPATH® is appealing to many due to its quicker recovery time and minimal tissue damage when compared with other traditional hip arthroplasty procedures.
The procedure explained
You may want to refer to our page on anatomy and problems for a more comprehensive understanding of the hip joint.
Essentially during the surgery, an incision will be made on the lateral (outer) side of your hip. Ligaments and tendons are retracted, or held out of the way (not cut), in order for the physician to access the joint. (On few occasions the piriformis tendon is released to fully access the hip joint, and is then repaired after the procedure.)
Once the bursae is opened to access the joint, the acetabulum is cleaned, and then the head of the femur is removed. A dome-like structure, called the acetabular piece, is fitted and secured into the socket part of the hip joint. Then, a ball and stick-like structure, called the femoral piece, is fitted and secured into the remaining neck and body of the femur bone.
The acetabular piece is often comprised of a metal and plastic piece, and the femoral piece is usually made of metal and occasionally ceramic. Once both ends are secured, they are fit together as your new hip joint.
To finish, the surgeon will proceed to stitch together the soft tissues (like skin and fascia) that were previously cut to access the joint.
You may note that in this procedure the new hip is actually made and fitted inside the incision as opposed to being a separate piece simply inserted. According to one source, because of this, the SUPERPATH® hip replacement technique has been nicknamed the “ship in a bottle” technique.
Comparing SUPERPATH® to traditional total hip replacement
Traditional hip replacement surgeries can be described as posterior approaches or anterior approaches. In a posterior approach, the patient lays on their stomach during the procedure and the hip joint is accessed from the body’s back or posterior side. In an anterior approach, the patient lays on their back and the hip joint is accessed from the body’s front or anterior side.
The SUPERPATH® technique has the patient positioned on their side during the surgery. This position allows the surgeon to access the hip joint with a smaller incision and less damage to tendons, muscles or ligaments. Theoretically, there is no need to cut tendons, muscles or ligaments when the hip joint is accessed from this position–there are a few exceptions of course depending on your unique case and anatomy.
Benefits of SUPERPATH® hip replacement surgery
Quick recovery time
The most appealing benefit of this technique is its quick recovery time. Patients have been reported walking within hours of the surgery. One woman reported returning to her tap-dancing class within two months of her SUPERPATH® hip replacement.
Shorter hospital stay
Of course, it depends on your unique anatomy and condition prior to the surgery, but overall patients walk with minimal assistance within the first day and are discharged from the hospital around two days after the procedure.
Less pain
Another benefit of this technique over others is that patients report less pain. Because there is less damage to other tissues surrounding the hip joint pain after surgery is reported much lower. With SUPERPATH® surgeries, there is also a much lower chance of dislocating of the joint during surgery, as compared with other traditional hip arthroplasty, which also decreases pain after surgery.
A smaller scar
The incision made on the lateral (outer) side of the hip is on average about 2-3 inches. This, of course, depends on the ability of the physician to access the joint from the skin and may be shorter or longer. There will also be a “puncture wound” a few inches below the main incision–you could expect this to look like a small dot a little larger than the size of a pencil eraser.
Risks of SUPERPATH® hip replacement surgery
Risks due to the surgery may include (but are not limited to):
- Pain
- Bleeding
- Infection
- Permanent or temporary nerve damage
- Extra bone or tissue damage
- Drop in blood pressure during the procedure
- Leg deformity
- Blood clot or clots (that could travel to heart or lungs)
- Delayed wound healing
- Excessive wear on the prosthesis that causes need for second surgery to repair
- Dislocation of the repaired joint
Is total hip replacement an option for me?
The hip joint is considered a weight-bearing joint, meaning it gets a lot of wear and use. If you have hip pain with walking, climbing, sitting and standing a hip replacement surgery may be an option for you. Other reasons for hip replacement surgery may include arthritis, and bone deformity or damage. In the early stages of hip pain and discomfort it may be possible to treat with medications, however if the pain continues or worsens surgery will likely be the best option. Nearly 90% of people who have had a hip replacement surgery feel almost immediately better after their prosthetic implant is placed. It is important to speak with your doctor or an orthopedic surgeon to determine if a hip replacement surgery is the right option for you.
Contraindications
Reasons you may not be able to have a hip replacement surgery may include:
- Acute or chronic infection or low immune system function
- Your bones are still growing
- Severe bone loss disease or history of bone loss disease (example: osteoporosis)
- You have a disease related to blood vessels, muscles, or nervous system
- You are receiving high doses of corticosteroids
- Obesity
What to expect and questions to ask your doctor
Your doctor will educate you on the risks and benefits of your surgery. They will likely have some guidelines for you to follow the day or night before (such as not eating or drinking after midnight).
On the day of your surgery you will receive an IV with some fluids and maybe some other medications, like an antibiotic or a blood thinner. Ask your doctor what preoperative medications will be administered.
For the actual procedure, you will either be given a spinal block or general anesthesia. Ask your surgeon which anesthesia they prefer and if you have a choice.
Once you have been properly prepared for the surgery, the procedure itself may take between 1-2 hours. Afterward, you will be transferred to a post-operative room where nurses will closely monitor your vital signs. During this time, they may also offer you medication for pain or nausea.
Depending on your medical history and unique condition you can expect to try to walk the same day as the surgery. The doctor may have you take medication for pain, nausea or to prevent infection or blood clots. Your hospital will most likely have a physical therapist to work with you on walking and specific exercises to strengthen the hip joint.
If there are no postoperative complications, you can expect to be discharged home about 48 hours after your surgery. Depending on your recovery you may be sent home with a cane or walker, however, most patients do not need assistive devices after a SUPERPATH® hip replacement.
Once you are home you may be a little restricted in your ability to perform normal daily activities. Ask your doctor before the surgery what physical restrictions you will have so you can prepare your house beforehand.
Suggestions for preparing your house for recovery
- Ask friends or family to bring meals.
- If you sleep up or downstairs, make a bed for yourself on the main floor or on the same floor as your bathroom and kitchen.
- Move all items used daily to waist high (to prevent needing to bend down).
- Ask friends or family to be available to pick up prescriptions from the pharmacy, take you to your follow-up doctor’s appointment, or do any other errand-running (you may not be able to drive for a little while).
Outcomes
Depending on your lifestyle, age and medical history hip replacement can be extremely worthwhile. Most patients are extremely satisfied with the decreased pain and increased ability to perform daily activities after their hip replacement surgery.
It should be noted that a replacement joint shouldn’t be expected to perform as well as your natural joint and can break or wear down. The rate at which an artificial joint could wear down or break however would depend largely on your anatomy, lifestyle and activity. In some cases a second surgery is needed to repair a hip replacement.
Physical therapy may be indicated, however with this technique there are often less postoperative restrictions. Many restrictions are to prevent joint dislocation. Because of its minimal tissue damage, there is less chance of joint dislocation after surgery because no tendons or muscles have been damaged.
What do these words mean?
Femoral– in reference to the femur bone (femoral head, femoral neck or femoral body would refer to a specific part of the bone)
Acetabulum– refers to the socket part of the hip joint
Hip arthroplasty- artificial hip replacement
Prosthesis- an artificial body part
Spinal Block– a type of anesthesia administered directly into an area of the spine; creates a “block” so that nerves going to a certain part of the body do not transmit the sensation of pain to that area
General Anesthesia– a type of anesthesia administered to put a patient “to sleep”
Bursae– cushion-like sac around ball and socket type joints
Osteoporosis- a bone degenerating disease
