Much has been debated about the optimal technique for total hip replacement and truth be told, long term outcomes demonstrate virtually no difference between techniques. Nevertheless, there are theoretical advantages to different techniques that may affect early outcomes in terms of return to function and vocational activities. Dr. Parsons has extensive experience in the posterior, anterior and superior (SuperPATH) approach to total hip replacement having performed hundreds of each. Here is his perspective based on careful observation of outcomes.
The anterior approach is not as muscle sparing as some would argue. Extensive release of the posterior capsule including the piriformis muscle is necessary to expose the femur during the surgery. In addition, resection of the anterior capsule leads to more tissue violation and a potential for more hip flexor tendonitis and anterior hip dislocation. Finally, the anterior approach has more blood loss and a risk of thigh numbness of up to 30% due to the proximity of the sensory nerve to the surgical dissection.
The SuperPATH approach was developed as a hybrid between the anterior and posterior approach, offering the best of both worlds. It has less blood loss, less capsular violation, less risk of nerve damage and less nonphysiologic positioning of the leg during surgery. It also does not require live fluoroscopy to position the implants so there is no radiation exposure as occurs with a direct anterior hip replacement.
The tissue sparing nature of the SuperPATH hip replacement allows patients limited hip precautions with extremely limited risk of instability due to the capsular sparing nature of the approach. This has become Dr. Parsons’ favored approach of all potential approaches for hip replacement. This selection is based on personal experience with patients who have undergone both approaches. Dr. Parsons is the only surgeon in NH currently offering the SuperPATH total hip replacement and has had patients travel from MA, VT, ME and OH for this surgery. Visit us to find out more.