THR Left Hip First - SuperPath vs Traditional

[LucyVanPelt]

Having my left THR on October 26, 2023. Once I am recovered from this one, I will have the right hip replaced.

My hips have been slowly "locking up" for years until now I have no range of motion on either side. I am getting around with forearm crutches. Found out three weeks ago that both hips are destroyed by arthritis and need replacing.

I have learned a lot about hip replacements lately. Our modern hip replacement surgery was invented by Dr. John Charnley in the U.K. in the 1960's. My mom had a right THR in 1977 while she was in her 50s. Her surgeon had studied under Dr. Charnley. She had a great recovery and walked without pain and without a limp for the rest of her life. Her implant showed no signs of wear after nearly 30 years. Her surgery was, of course, "traditional" and she had a very long incision on the side of her right leg.

My GP, whom I have had as my doctor since 2000, sent me to a "traditional" hip surgeon. When I went to see him, I brought up the subject of "Minimally Invasive Surgery." His immediate response was, "It's a gimmick! A 2-inch incision plus a 3-inch is still a 5-inch incision!"

He was referring to the SuperPath technique vs the Traditional technique. The SuperPath technique uses an anterior 2-inch incision to place the acetabulum cup and a posterior 3-inch incision to place the femoral stem. Today's Traditional technique uses a lateral 5-inch incision to do both.

There are 2 medical schools in my area and both of them are promoting the SuperPath technique. People are coming here from all over the world to get this newest type of THR. I want the very best, so I was puzzled why my doctor sent me to a "traditional" surgeon.

I called a friend who had a THR with the SuperPath technique and asked about her long term recovery. She is still having pain and must use her hands to lift her leg up into her car. She knows 2 other people who also had SuperPath THR and both of them also have pain and range of motion issues. One of them is already looking for another surgeon to get it re-done. All 3 of these people had different surgeons, but similar lousy outcomes.

Then I called a woman who had both hips replaced (12 weeks apart) about 3 years ago using the Traditional technique. She is doing great with no pain and no limp. She has a brand new life again.

The SuperPath appeals to my vanity. "We can give you a brand new hip with a 2-inch incision below your bikini line in the front and a 3-inch incision below your panty line in the back. We cut through less muscle so your recovery time is faster. (You'll have to forgive us if we cut that nerve on the front that governs being able to lift your leg into the car.)" However, the surgeon is hindered by the tiny incisions and must try and make up for not being able to see and get to everything by using robotics or x-ray imaging.

I wrote to my traditional surgeon about all this (through my medical phone app). He wrote back and said you may or may not have a good outcome using the SuperPath, but the outcome will ALWAYS be compared to the Gold Standard, which is the Traditional technique and what he still does. He said he chooses to use the traditional technique because of its track record of a good outcome and because of its reproducibility - meaning he can do exactly the same surgery on you, me, and the next person who needs it.

I am interested in the long-term results even if it takes a few more weeks of recovery. What good is it to recovery quickly if you're still in pain and don't get the results you are seeking?

I have shared all this to help someone who has the same questions I had. "New" does NOT always mean better, although we have been conditioned to believe that it does. Whatever decision you make for yourself, may you have a blessed outcome!

 

[benne68]

to BoneSmart, @LucyVanPelt, and congrats on getting your surgery scheduled!

You have plenty of time to prepare; here's BoneSmart's helpful guide.

If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:
Score Chart: How bad is my arthritic hip?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?

If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:
Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?

And if you want to picture what your life might be like with a replaced hip, take a look at the posts and threads from other BoneSmarties provided in this link:
Stories of amazing hip recoveries

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.
While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Layla]

Hello and Welcome to BoneSmart. Thanks for joining us!
Like anything, you'll have those who are satisfied customers and those who weren't. It is best to find a good surgeon that you have researched and have confidence in, which it seems you have.

My mom had a right THR in 1977 while she was in her 50s. Her surgeon had studied under Dr. Charnley. She had a great recovery and walked without pain and without a limp for the rest of her life. Her implant showed no signs of wear after nearly 30 years.

This is awesome. I love it!

Joint replacement surgery is one of the most prevalent surgeries performed worldwide. The outcomes of these surgeries have become excellent based on a number of techniques changing over the years. The implants are durable and long lasting, with longevity much greater than before offering an increase in the likelihood you’ll never have to experience this procedure again.

Best Wishes and lots of comfort to you as you await your first surgery.

 

[djklaugh]

@LucyVanPelt Welcome to BoneSmart! I've been coming to BoneSmart for over 12 years and have read threads of folks getting hip replacements using every possible technique, approach, and method that is available. And I have seen excellent results from all of those .... and not so excellent results for all of those. IMO, what makes for a successful out come is 1) the expertise of the surgeon - no matter what way he/she is using if he/she does a lot of these and is excellent at his/her work; 2) the general good health of the patient - not necessarily athletic or in peak physical form (I certainly was not) - just overall good health; and 3) HR recipient being willing to heal first and then get into what ever "training" they feel they need to return to activities they love.

The other consideration I have for you concerns your statement of having both hips being very deteriorated. Your story sounds much like my own ... and I was 11 years older than you are now. I had one hip so bad it had fused to my pelvis so zero range of motion and the other hip was nearly as bad. Did you speak to the surgeon you saw about the possibility of having a bilateral hip replacement? That is getting both hips replaced during the same surgical session? I was rather stunned when my surgeon actually recommended that to me. BUT, (again IMO) it really was the very best way for me to go. Each person is unique and there might be genuine medical reasons why a BTHR would not be appropriate for a particular individual. The reasons my surgeon gave me for doing this were 1) he believed doing one surgery was actually less of a risk than doing two - only one session of anesthesia and only one hospital stay. 2) Only one recuperation period. 3) I would be able to return to a normal gait faster because if he did 2 separate surgeries I would still be limping on one bad hip between procedures. 4) He would be able to make sure both legs ended up the same length so I would not have a leg length differential problem ( something that does sometimes happen when folks get hip replacements at different times).

If you are interested in the possibility of a BTHR you can read my saga (link is in my signature) - it's old and does not get updated any longer - and 12 years on I am still very, very glad that is the way I opted to go and very, very happy with 2 pain free hips!

Best of every thing what ever you decide to do. And do ask questions and keep us informed - we do like to help!

 

[LucyVanPelt]

Thank you Deb. I am encouraged to hear you have had a great recovery in spite of two very deteriorated hips. I hope for the same result.

I have wondered about having them both done at the same time. I will ask about this. It does seem like it would be better to get it all over with at once so I'm not limping around on a bad hip. Will keep you posted.

 

[Eman85]

I knew nothing about approaches or any of the other stuff thrown around about THR's. I knew my hips were real bad and that my left had hardware in it that needed to be removed to do a THR so I went looking for a competent surgeon. It wasn't until after I was scheduled that I asked where they were going to make the hole as I'd had 2 prior surgeries and my side looked like a football already. As it turned out my OS used posterior method. In the long run especially with my left it just made sense for him to have a bigger window to work in. With my right which was very bad and locking it was good that he had room to work as he found a bone cyst and addressed it while he was in there. I'm glad I waited over the 3 mos to have my 2nd done and I really don't have a scar just light lines like a pink pencil mark.

 

[SurreyGirl]

This is very interesting. My surgeon is very traditional and refuses to do anything other than the Posterior approach. My scar from 5 years ago is a very thin white line - ok it’s long but one can hardly see it.

I went back to him on 9th August for an op on my right hip. Also posterior Charnley Method.

After a 2 year wait (previous one was 3 years), this recovery is going better than the first., yes it is a big scar and I got sone pain in the first few days but six weeks on it is recovering well.

Lots of people have the Anterior approach and do well. My surgeon said “I am a big lady and he wanted plenty of room to maneovre.” From the 2nd day after the op I could lift my leg, sided with a strap, into a car and the leg felt vey solid.

Just do some more research and I am sure you will make the right decision. Best of luck..,

 

[Solar7]

Hi Lucy,

Welcome to Bonesmart! As someone who has done a lot of research on this, I think you may be confusing your terms and approaches. Posterior and SuperPath are not the only two options, and it's crucial to understand that not all minimally invasive approaches are SuperPath. There are even minimally invasive posterior procedures (along with anterior and lateral).

There are resources on this site about all kinds of approaches (I can't link them now as the main site is undergoing maintenance), but the three main types of approach are posterior, lateral, and anterior. They all provide their own ups and downs, and anyone's individual health situation can change what is best for you, so it's worth looking into, but SuperPath is almost in its own, 4th category. SuperPath is by far the newest procedure, having only originated around 2011.

However, the anterior approach and lateral approach are different methods that have changed since the first hip replacement method originated, or the posterior approach.

As a younger person only 4-5 days removed from the surgery, I felt I wanted anterior, as it does not cut any muscles. SuperPATH, lateral, and posterior do. Anterior is slightly newer as well, meaning less doctors have been taught to do it from the start. I'm not advocating for a specific type, but you're limiting your options by not exploring lateral and anterior as options outside of SuperPATH.

Best of luck!

 

[hhhooray]

3) HR recipient being willing to heal first and then get into what ever "training" they feel they need to return to activities they love.

I absolutely love this as I kept trying to push the exercises and recover "faster" but more than once found out that letting things heal more first was the best path for me to recovery... thank you!!!

@LucyVanPelt , looks like you've done some good research. After it's done, listen to all the wonderful people here and they well help you retain your sanity, give you hope and the best recovery advice!!

 

[Iloveemma]

I had an anterolateral incision for both left hip revisions. I had almost no pain postop. I iced it a lot. They don’t cut any muscles. The hip revisions are another story.
Thanks to Depuy, my metal on metal started wearing and flaking off cobalt and chromium. And I had muscle damage. I may limp for the rest of my life.

 

[LucyVanPelt]

I passed my Pre-Op tests at the hospital this week. Surgery is still planned for Oct.26 to do a left THR. I was given 5 exercises to start doing in bed morning and night so I'm being faithful to do those. I ordered a hip kit from Amazon and a toilet rail system for my elongated taller toilet. I have also learned that my surgeon uses a 5-inch lateral/posterior incision directly over the hip joint, so the scar will be covered by a swimsuit bottom. Yay! Once the surgery has been done, my focus will be to make sure I follow the "90 degree rule" for 6 weeks. Getting excited!!

 

[Jaycey]

Once the surgery has been done, my focus will be to make sure I follow the "90 degree rule" for 6 weeks.

I was worried about this before my first THR. But in truth - my hip just didn't want to move past the 90 degrees in the early days. After my second THR I had no restrictions but the experience was the same. Limited ROM at first.

Here's an article that might be of interest: Dislocation risk and 90 degree rule

 

[Layla]

Best wishes tomorrow, Lucy!
Please join us on the healing side once you're feeling up to it. We'd like to support you as you begin healing and have some Recovery Guidelines to share with you. Hope to see you soon!
@LucyVanPelt