SuperPath Hip Replacement?

[BeckyR]

calikat, There is definitely a learning curve when surgeons shift their methodology from what they are used to -- either to anterior, or SuperPATH. There are surgeons who do the SuperCap and the PATH -- both precursors to SuperPATH. Wright medical sells the tools/instrumentation for SuperPATH, but surgeons can use any implant on the market, depending upon the needs of the patient. They don't have to use Wright implants. That is one of the advantages of SuperPATH -- it really gives surgeons maximum flexibility. With the anterior approach, surgeons can use implants from various manufacturers, but they have to be especially made for the anterior approach (I believe because of size restrictions). Also, the anterior approach cannot be used on all patients...it depends on body type. Even surgeons using the anterior approach will tell you that not all patients qualify for that approach.

I do believe that the best strategy is to find the surgeon you want to work with, and trust, and to go with the approach they use and are comfortable with. Hip replacements using the traditional posterior approach have been fabulously successful. Based on what I've learned, however, I would not want anything other than SuperPATH, so long as I had a surgeon who was totally experienced in using it. Fortunately, I do, because my surgeon helped develop SuperPATH and has performed more than 600 of them so far.

If I didn't have my current surgeon, I would probably go with a mini-posterior, because I'd be too afraid of the potential for nerve damage from the anterior approach. But I'm only speaking for myself on that.

 

[Jamie]

I feel that it is right for everyone

sandybeach Sorry, but I must take exception with this comment. I realize this is your opinion, but it is not a good idea to make such blanket statements about "everyone." Even professionals in the medical field would not make a statement that there is one perfect approach for all patients. If that were so, then all of the surgeons worldwide would be using it. It obviously was a good solution for you, however, and I'm glad you are posting about your experience so others may learn what you have gone through.

The truth is that there is no one way to have a successful hip replacement. Approaches and implants in the end are just the tools to get the job done. The real skill is in the hands of the surgeon and THAT is where a person needs to place their time with research. Find the best surgeon you can....one you are comfortable with who does 200 or more of the surgeries you need each year. If a particular approach interests you, meet with surgeons who use it and go from there to make the best decision for your individual circumstances.

 

[calikat]

BeckyR the surgeon I consulted with in Santa Monica explained an approach to me that sounded like the SP, but he did not call it that. He just called it a min invasive technique. No muscle cutting etc., using arthroscopy etc. He used Striker implants. I have to say that after my experience with the anterior I regretted not choosing him because for me, the anterior was no piece of cake. ;)

 

[BeckyR]

calikat, Yes, there are many different approaches that are considered "minimally invasive," but the SuperPATH approach really is unique. I saw an article differentiating "mini" and "micro" invasive THR techniques, and SuperPATH was considered micro. There is a wonderful surgeon near me who just started doing anteriors, but up until now he did what he called a "mini-posterior" with a 4-inch scar. In more than 2,000 surgeries, he never had a hip dislocate. If I hadn't found my surgeon, I would have gone to him and had the mini-posterior. It did have some post-surgical restrictions, and was not the same as SuperPATH, but he is a great surgeon. The PT I like so much used to work for him and respected him highly.

I would never say that there is only one road to success, because I know that all the different methods do succeed on countless patients, and they have their differing strengths, but I do think it is fair to say -- with a great degree of certainty -- that the SuperPATH is the LEAST invasive. It is not only about whether or not muscles are cut, or how many inches the incision comes to. It is about the amount of trauma to soft-tissue inside the hip/leg, and from all I've heard and read, there is nothing that can match SuperPATH in that area. Not the anterior, not the mini-posterior, nothing. The reduced trauma does help speed healing, but it is still major surgery and there is still a recovery process/time, which varies from patient to patient.

I read through your entire thread, and you have had a very difficult time. There is no way to know whether you would have had an easier time with a different approach; or how much easier. So much depends on the individual -- your body, your bones, your own speed of healing, etc.

It is so good to know you are doing well now. The memory of your pain will fade with time; the gains will be with you throughout your life.

 

[sandybeach]

Jamie you don't think that if you have a surgeon that can operate with an approach that is as least invasive as it can get, that's not for everyone? You get all of this with zero restrictions. Other types of THR surgeries are very successful or they wouldn't be performed but through improvement new techniques are created. I would want to be told about the superpath technique and be given the option to go this route if at all feasible, many circumstances won't let patients go this way. I read about the after surgery care, restrictions and down time. I compared those to what the superpath was offering and couldn't believe the difference. I searched to see how close one of those surgeons are from where I live and I was so happy to find there is one in Minnesota. I called and made an appointment within a few days of finding him. The day I met him I knew he was the doctor for me. I have recommended him to two other people and the two other people have also had successful surgeries with him.

 

[bottomshollow]

Well, sandybeach, there are folks whose anatomy, sort and degree of degeneration, and other conditions, including financial, might not allow them to take advantage of superpath. I could not have afforded to go outside my area for something like this. And the truth is, one size does NOT fit all.

We are aware that everyone on the forum who has had this approach has been very happy with it and their results, but that does not make it the end all and be all for everyone. And keep in mind that suggesting that everyone should have this approach is a bit of a slap in the face to those who do not select it.

We want you to feel free to continue to advocate for this approach, but a little restraint in pushing it for everyone would be appreciated.

 

[calikat]

One of the OS's I spoke with said that if there was a "best" way, all surgeons would be doing it. They all have their own opinions about what is best. That being said, I don't know if I would be so heart set on one approach over another. The skill of the surgeon is the most important. I also believe that there are other surgeons who use a similar SP method, but don't call it that. All three surgeons I consulted had NO restrictions regardless of approach, and they all claimed to not cut any muscles. Just be sure to ask a lot of questions during your consult. I had it in my brain that I wanted an anterior approach because of what I had read on the internet, so I may not have listened to the first surgeon as well as I should have regarding his technique. There is a lot of marketing out there.

 

[Butterfly]

Well, my surgeon said I was not even a candidate for the anterior approach, which I had wanted. Because of the deterioration in my hip bones and sockets, he said it would be nearly impossible to clean out all the mush without having the larger operating field provided by the posterio-lateral approach. Some work had to be done on my sockets, too, and he was unwilling to attempt all that with any other approach. He is a fellowship trained, board-certified, very successful, well-respected and up-to-date surgeon here and I trust his judgment. So far, I've had a very successful recovery. I don't think that one approach or another is the best for everyone.

 

[BeckyR]

Even though I am a HUGE fan of SuperPATH, I would rather have a superb surgeon who did another approach (like the mini-posterior) instead of a second-rate surgeon who used SuperPATH. The skill of the surgeon really is paramount. Nevertheless, from everything I've read and learned, SuperPATH really is the least invasive approach of all -- less invasive than the anterior approach, than mini-posteriors, and than similar "non-invasive" approaches. It is not true that all surgeons would switch if an improved methodology was found, because there definitely is a learning curve and many surgeons don't want to go through that. Understandably, they believe "my patients already do well," and they don't want to be doing something with which they aren't as comfortable. In my market (Southeast Florida) there is huge competition for THRs, and patients are now beginning to demand less-invasive approaches, so some of the more reluctant surgeons are beginning to switch (mostly to anterior).

All surgeons will promote and market their own approach -- that is only human -- but there is definite evidence about which approaches are less invasive than others. Also, SuperPATH is more adaptable than anterior, because any implant can be used. Many patients who don't qualify for anterior DO qualify for SuperPATH. Dr. Jimmy Chow published an article which, among other things, discussed several massively obese patients he has operated on with SuperPATH (I think about 400 pounds, but can't remember exactly). He discussed some complications that arose and how they were dealt with; modifications he made, etc.

In one way, SuperPATH is accessible to just about all patients who can tolerate a hip replacement at all, because -- worst case scenario -- it can be converted in moments to a traditional posterior approach if there are unexpected complications.

This doesn't mean that it is BEST for everyone, because not everyone has access to it, or that they will necesssarily like the specific surgeon using it. Perhaps as time goes by, and new evidence accrues, SuperPATH will become the new standard, but that would take a lot of time and change, and would require that thousands of surgeons choose to switch to this approach. That may never happen. At least it is good to know that this option exists, and what benefits it offers.

 

[BeckyR]

nadineaurh, Welcome to BoneSmart! I wasn't sure, when I read your posting, whether you have had your hip replacement, are considering having it, or have found a surgeon and are planning to have it. If you stay on the site, you will find so much support. Most of us who have had hip replacements are SOOO happy to have had it done. It has given us a whole new life. I will tag Jamie and Poppet to make sure that someone gets back to you with additional information and support.

 

[Freaky freak]

BeckyR I have also done a lot of research on the less invasive procedures and have chosen Dr Kurtz who trained on SuperPath and the anterior approach. I can hardly wait for my first visit with him on Monday. I have had several surgeries including arthroscopies on both hips and tend to recover well so the less invasive procedure may allow me a bit quicker recovery, but not setting any expectations for myself.


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[calikat]

Freaky freak good luck on Monday. Let us know how it goes. <3

 

[BeckyR]

Freaky freak, So glad you have chosen Dr. Kurtz, and will be flying the SuperPATH express! Dr. Kurtz has a wonderful reputation and you will be so glad you have chosen this approach. It is still major surgery, and everyone's recovery differs, but it does significantly shorten the recovery period and gives the least possible amount of soft-tissue trauma. Apart from a few minutes of extreme shivering and cold in the recovery room, and about two minutes of pain until they controlled it (again, in recovery), I never really had anything I'd classify as pain after the surgery. I did take painkillers by the clock, but I rapidly stepped down from the really strong stuff (Dilauded, oxycontin), and was pain-free with only Vicodin, stepping that down to lower doses within a week after returning home. I didn't rush to stop the pain-killers, because I really wanted a pain-free experience, and the Vicodin didn't cloud my thinking. I was able to drive by the third week, even though it was my right hip (driving leg), but I could only drive if I wasn't taking Vicodin in the daytime (which I rarely needed by that point). It did take me a few weeks to regain enough range of motion to put on socks or tie my own shoe on the right foot. I had discomfort in the form of awkwardness, needing a walker or cane for a few weeks, and it took me some time to build up stamina to walk distances like 3/4 mile. My walking was also much slower than normal for about three months (gradually improving). But my posture DRAMATICALLY improved immediately after surgery, and the pre-surgery pain was gone immediately. I had forgotten I had a new hip within four months, and the new hip feels 100% natural. Good luck with the surgery. The new year will be the start of a new life for you!

 

[sissy46]

I've been following this thread with great interest---not for me, this time, but for a south Florida friend to whom I have suggested a consultation with Dr. Grandic for the SuperPATH. He's an avid fisherman, softball player and beach walker, and if he needs a THR he wants the fastest possible recovery time. He saw how quickly I recovered from my anterior left THR but I have told him there might be something even better, since he's in that neighborhood anyway.

As far as recovery from any of the various approaches, I think much depends upon an individual's level of fitness and flexibility prior to surgery. For example, I was able to put on my own socks and stoop down to pick something up off the floor before I even left the hospital. I had excellent pain control, and never experienced any post-op pain that I would call severe. I was off the Percocet except at bedtime by day 7, so I was able to start driving then. I really didn't need the walker when I got home (to my second floor condo) and I used the cane for a week or so in public just as a defense mechanism, so people wouldn't bump into me. Prior to surgery, walking was painful but I was still bike riding and kayaking right up until the day before. When I asked my surgeon how long I had to wait before biking and paddling, he said "4 weeks," so on the 28th post-op day I was back on the water; tremendous psychological boost, I felt like I had my life back for sure.

I had no leg length discrepancy, no nerve damage. If I weren't still saying "wow," I could forget I ever had a replacement. There is a guy, MaxBuck, who may have had an even more stellar recovery than mine---see his thread.

I'm all in favor of the least invasive surgery and the quickest recovery time, but given my excellent experience with the anterior approach, I would not travel out of town to have SuperPATH. I asked my surgeon if he was planning to learn it and he said he was thinking about it.

 

[BeckyR]

sissy46, It sounds as though you had a wonderful surgeon and great results. The great majority of people who go through the anterior approach swear by it (from what I've heard). Your prior condition, speed of healing, immune system, etc., all have a profound effect on how quickly you get back to normal. Everyone is different. I found that I progressed more quickly than some SuperPATH patients in some areas, and more slowly than others in other areas! I don't think I would have traveled out of town for my surgery if Dr. Grandic hadn't been available here, because there are other great surgeons who get great results. I probably would have gone with a mini-posterior, from a surgeon who was highly recommended. Now that I've experienced SuperPATH, I don't think I'd want a different approach, but if I were actually faced with the choice, the ability to have a great surgeon close to home might make me change my mind. So glad your surgery went perfectly!

 

[BeckyR]

sissy46, So glad your friend is going to see Dr. Grandic. He won't be disappointed!

 

[sissy46]

Becky, I just wish he'd get an appointment now---he thinks it is his back, not his hip, and wants to try PT first. Right. How long did it take you to get an appointment, and then get surgery scheduled, with Dr. Grandic?

There are advantages to having a good ortho doc close to home. I called his office Monday because my right wrist was hurting so badly I couldn't turn the key in the car ignition without severe pain. Didn't know whether it was a fracture, tendonitis, arthritis, or what. They got me in that afternoon, did an X-ray and exam, diagnosed De Quervain's tendonitis, gave me a splint and advice. It usually takes a couple of weeks to get an appointment so I really appreciated that.

 

[calikat]

I was able to put on my own socks and stoop down to pick something up off the floor before I even left the hospital.

I could do this also...but I felt very stiff and awkward. I wonder sometimes if I just moved around too much when I returned home from surgery, and that is why my leg still feels so achy. Maybe I messed something up? When I got home I tested things out...bending and touching my toes, sitting and getting up from the floor etc. Certain movements that use external rotation cause pain. I don't know if my expectations are too high? I had anterior, but I don't feel like I sailed through pain wise. The first 8 days were rough. I could not seem to manage the pain very well. Maybe because I was on so much pain medication before the surgery. I used a walker or crutches the first week. The walker was for the house, the crutches were for outside, and I ditched the crutch at day 14. I drove on day 13 if I remember correctly. I also drove myself to my 2 week follow up. Maybe I am just a whiner...I don't know. But I still have so much pain at night. I am taking Celebrex which helps. I have arthritis all over so it really is a necessity.

The great majority of people who go through the anterior approach swear by it

I cannot count myself as one of them. I am very interested in the SP approach for ny left hip. Unfortunately I don't know if there is a Dr. in Los Angeles does this? Do you know Becky? I think I have found a few that do the PATH? But it appears that they cut the piriformis and then repair it at the end with that method. I should really go consult with the first OS I spoke with about THR, but I feel uncomfortable since I did not choose him to do the replacement. I definitely regret not consulting with him a second time.

 

[BeckyR]

sissy46, I was able to get an appointment with Dr. Grandic quite quickly, and was able to get the surgery booked exactly when I wanted to, although I first saw him in April and knew I'd want to have the surgery in July, after Medicare kicked in (and I was on summer vacation). I could have gotten a surgery slot earlier. His office is so helpful and warm in finding space for appointments. For a first appointment, he needs more time with the patient. Please tell your friend that one of the first things Dr. Grandic will do is to determine whether he needs hip surgery, or whether there is a back problem that needs to be addressed, whether physical therapy should be tried first, etc. He is not in a rush to say "hip surgery is the way to go!" It is a stepwise process. Most doctors approach it this way. But he needs to get the process started, and seeing Dr. Grandic is a great first step. He is totally trustworthy and on the patient's side.

 

[BeckyR]

calikat, There is a SuperPATH surgeon in Chula Vista, California (near San Diego) named Harbinder Chadha. Here is the link to information about Dr. Chadha and other SuperPATH surgeons: broken link removed: https://www.superpathhiptechnique.com/patients/find-physician.asp#chadha

I think that Dr. Chadha is one of the SuperPATH surgeons who helped train the first surgeon to take SuperPATH to Australia. Having his fellowship at Scripps is very good -- it is such a highly-respected institution.

Good luck, Calikat! Let me know if he is close enough to where you live to start the consultation process!