Hip Replacement

This procedure is the definitive treatment for severe arthritis of the hip joint causing symptoms that are intrusive in a person’s day to day life and not adequately controlled by non-surgical means.

Common symptoms include pain in the groin, thigh and buttock. Often activity related and typically affecting simple things like putting one’s shoes and socks on or being able to reach one’s toe nails, getting in and out of cars etc.

Hip replacements are major operations with risks, albeit very low. However, with major improvements in biomaterials and surgical techniques, they have become some of the most successful (if not the most successful) operations of the 21st century with excellent results and very high patient satisfaction.

The Procedure

In a Hip Replacement, the diseased cartilage on the femoral head (ball) and the acetabulum (socket) are removed and replaced with prosthesis.

Materials Used

These are usually in the form of 4 components. The acetabular shell (metal), insert (Polyethylene or Ceramic), prosthetic femoral head (metal or ceramic) and the femoral stem (metal).

Bearing Surfaces

The movement happens between the prosthetic femoral head and the insert. This is known as the ‘bearing surface’. The possible combinations are Metal on Polyethylene (MoP), Ceramic on Ceramic (CoC) or Ceramic on Polyethylene (CoP). Until recently, metal on metal (MoM) articulations were also in use. These are no longer in common use after the failure of one particular brand of this type of bearing surface. The concerns are associated with early failure and metal toxicity.

Amongst the currently used bearing surfaces (MoP, CoC, CoP), there is no ‘best’ one. They all have their perceived pros and cons and surgeon preference is often based on their experience and patient factors.

Dual Mobility Hips

There are two prerequisites to stability in a hip replacement: The Soft tissue envelope (muscles and ligaments) and the design and position of the implant. If the first factor, muscles and ligaments, are compromised but cutting / detaching them as may be done in common methods, to compensate for their loss / reduced function, the dual mobility concept aims to alter the design of the implant this to achieve stability.

Dual Mobility implant designs are an exciting new concept that changes the bearing design to allow movement to happen at 2 interfaces instead of the usual 1 surface. Instead of a ‘ball in socket’, it is a ‘ball in socket in another socket’. The benefit of this concept is that the 2 interfaces allow for a greater arc of movement before dislocation would happen and hopefully reduce the risk of this complication.

In SuperPATH, the soft tissue function is maintained and therefore there is no need for dual mobility design as the construct is already stable.

Approach or Technique

Hip replacements can be performed by various methods or ‘approaches’. Approaches have been constantly evolving since the early hip replacements half a century ago. The aim of this evolution being to minimize tissue damage associated with the operation and maximize preservation in order to reduce the morbidity and improve functional recovery.

The posterior approach, also commonly referred to as the traditional method, is the default approach for orthopaedic surgeons in Australia as this is the technique all orthopaedic surgeons in Australia are trained in. In this method, the incision is on the side of the thigh and the hip joint is accessed through its back. The muscles and ligaments on the back of the joint are incised to gain access to the joint and a hip replacement can be safely and efficiently performed. It is the most common technique worldwide and the most tested and trialed method with good results.

The anterior technique, whereby the incision is made from the front, has been popularized in Australia over the last 10 years or so on the premise of muscle sparing. This technique accesses the hip joint from the front and varying degrees of muscle sparing can be achieved. The anterior ligament (Iliofemoral ligament) is incised and a hip joint is exposed for replacement. This technique has also had good results in the right hands.

Whilst there are various ways of doing a Hip Replacement, as long as it is done well, a good result can be expected irrespective of technique. Tissue preservation certainly has some benefits, especially in the short term but the technique your surgeon is most comfortable with is always the safest way.

Recovery

Whilst the overall recovery can take a year (by the time all healing plateaus out), with newer techniques like SuperPATH, patients can often go home in a day or two after surgery and, all going well, can return to most functional activities by a couple of weeks. This is the least invasive technique when considering the soft tissue envelope around the hip and unlike other minimally invasive methods, obesity/ size/body habitus/age/ general health are not limitations to the use of SuperPATH.

Anyone who is a candidate for hip replacement could potentially have it done using this technique and so far, the short to mid-term results look extremely promising. There is now plenty of evidence to show that it is a safe and reproducible technique in experienced hands.

Longevity

The joint replacement can often be expected to last a couple of decades. Patients can expect to get back to most if not all of their pre-operative or sometimes even pre arthritis activities. Impact activity such as running, jogging, jumping though, is not recommended.

SuperPATH

In the last decade a new technique, called SuperPATH, has been developed in the US.

Associate Professor Sol Qurashi was the first SuperPATH trained surgeon who pioneered this technique in Australia.

SuperPATH is a very innovative development in hip replacement surgery that allows us to perform hip replacements in a manner which encourages quicker functional recovery and eliminates many of the limitations often placed on patients after hip replacement surgery. These includes the common ‘hip precautions’. This is because of the unparalleled preservation of the hip ligaments and minimal muscle sacrifice making SuperPATH the least invasive and most preserving method when considering the soft tissue envelope around the joint

SuperPATH utilises an incision typically about 3 inches long. Both the anterior ligament at the front and posterior ligament, at the back of the hip joint, along with the short external rotators and ITB are maximally preserved.

The hip is replaced without surgically dislocating the joint. This allows us to “build” the hip replacement ‘in situ’ with minimal relative disturbance to the soft tissue envelope like building a ship in a bottle without disrupting the bottle.

The heavy emphasis of this technique’s philosophy on ‘preservation’ has some major benefits:

  • Quick functional recovery
    • Patients often walking within a few hours of the surgery.
    • Return to functional activities within days to weeks.
  • Reduced limitations, particularly in the short term after surgery
    • Inherent stability making the usual ‘hip precautions’, often associated with other techniques, not necessary.
  • Pain profile
    • Anecdotally, patients experience less pain and their pain medication requirements are significantly reduced.
  • Low Complication Profile and Results
    • SuperPATH has shown to be a safe and reproducible technique in the right hands. Initial results show excellent patient satisfaction and a very low complication rate. Long term result are unlikely to be much different across techniques as they are a function of implants, not technique. SuperPATH is not specific to one implant and a variety of implants can be used with this technique.

For further information on SuperPATH please contact 1300 364 061

Introduction of SuperPATH in Australia

Associate Professor Qurashi’s interest in Micro-Invasive Hip Replacement Surgery came about after he met Dr Jimmy Chow, the co-inventor of the SuperPATH technique. After carefully observing the technique, cadaveric sessions and operating with Dr Chow and other co-inventor Dr Chada, in the United States, Associate Professor Qurashi felt strongly about the merits of this method and the benefits it would bring to patients having Hip replacement surgery in Australia.

Whilst this was all very exciting, SuperPATH had not been introduced outside of the US at that stage and as such, instrumentation and implants used in the US were not readily available in Australia. Further, certain implant styles (modular stems) previously used in Australia with other techniques and used in the US and with SuperPATH at that time were not supported by the Australian literature. Associate Professor Qurashi strongly believed in the technique but the quest for the desired result also needed the right implant and appropriate instrumentation to use them. This led to many modifications instituted by Associate Professor Qurashi and his team to the tools and choice of implant so as to make it ‘in line’ with current best standards.

Finally, in July 2013, the first SuperPATH Hip replacement in Australia was performed in Nepean Private Hospital, Sydney. Since then, SuperPATH has enjoyed excellent success. By 2016 and over 300 SuperPATH cases, the results of very first 100 SuperPATH surgeries (the so called ‘learning Curve’) were published in a peer reviewed journal with excellent results and a very low complication rate (Qurashi et al, SuperPATH Minimally Invasive Total Hip Arthroplasty – An Australian Experience JISRF • Reconstructive Review • Vol. 6, No. 2, July 2016).

By 2025, and over two thousand SuperPATH cases later. the functional results remain excellent with the complication / revision profile very low and well below the expected benchmark rates in the National Joint Replacement Registry. In particular, the rate of infection and dislocation are extremely low compared to expected benchmark rates. This includes patients of all shapes and sizes including in very obese patients, often not considered candidates for minimally invasive methods, but suitable for SuperPATH.

This is very encouraging and whilst long term results beyond 12 years are yet to be seen, based on current 12 year results, we anticipate these to continue to be nothing short of excellent. The influence of technique on results i.e., those seen in the short to early mid-term, are impressive.

Associate Professor Qurashi is also a participant in the Australian National Joint Register (AOANJRR) and the Arthroplasty Clinical Outcomes Register (ACORN) register which are the essential tools of measuring performance and results of Joint Replacement Surgery in Australia.

Results in Australia:

More about SuperPATH please call 1300 364 061

More Information

www.superpathhips.com.au

www.chowhipandknee.com

Hip Arthroscopic Surgery

This is a procedure specifically reserved for patients that have Femoro-acetabular impingement (FAI) or sizable and unstable tears in the acetabular labrum in the absence of significant arthritis and have not responded to simpler non-surgical methods. Whilst, if done for the appropriate indication, it can be very successful at improving symptoms, its long term benefit is unclear.

American Academy of Orthopaedic Surgeons

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