Hip Procedures

Northern (SuperPath) MIS approach for Total Hip Replacement

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Summary:  This Minimally invasive Approach to the hip uses the northern most route to the hip joint thereby maximizing stability to allow a rapid recovery. Because it readily converts to a standard posterior approach, there is no additional risk.

Features:

1. Incision is above the tip of the hip.
2. Complete preservation of the posterior muscles of the hip
3. No disruption of the anterior capsule and muscles of he hip.
4. Piriformis Release Only (PRO) technique
5. No need for a special table.
6. Combines the pioneering advances of the Path® technique for the socket and Supercap® technique for the femur.
7. No dislocation technique. The femur is prepared in a natural state. This greatly reduces the risk of a spiral fracture of the bone from torque and dislocation.
8. Potential decrease in swelling and risk of venous thrombosis. The avoidance of dislocation and compression of the femoral vessel should help reduce vascular related complications.

Potential Advantages:

1. Faster recovery by virtue of preservation of the key anterior and posterior structures, and decreased swelling of the thigh and leg.
2. Greater flexibility because of rapid and aggressive physiotherapy with minimal hip precautions.
3. Functional return: cane by 2 weeks, no assist device typically by 3 weeks.
4. Decreased risk of transfusion by avoidance of dissection of the vascular posterior and anterior elements.
5. Decreased risk of excessive lengthening. The in-situ (no dislocation) technique leaves all hip restraints in place. This prevents inadvertent gross lengthening, a common risk in traditional approaches.

Potential Added Risks:

1. None. Because the northern approach is technically on the posterior side of the hip midline, it can effortlessly be converted to a traditional posterior approach with no penalty. This is in contrast with the anterior approach, which in case of trouble requires closure, repositioning and re-operation through a separate posterior approach.

Evidence Based Results:

1. Percutaneously Assisted Total Hip Arthroplasty (Path): A Preliminary Report,  Penenberg B,Bolling WS Riley , J Bone Joint Surg Am. 2008; 90 Suppl 4:209-20
2. Pending clinical series results from Murphy S (Harvard) and Meere P (NYU Hospital for Joint Diseases)