Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Abstract

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.

Figures

Fig. 1

1 Pre-operative radiograph. The patient’s acetabular component has shifted, and the THA has recurrent anterior dislocations. 2 Intra-operative photo showing custom cage-cup implanted. Probe is pointing to intact external rotator complex. 3 Post-operative radiograph. The patient’s cage-cup has been implanted according to pre-operative plan. Additional offset was used to adjust for patient’s prior instability

Fig. 2

1 Initial radiograph. Note the cemented acetabular component and retained pelvic hardware. 2 Re-implantation radiographs. Allograft struts were used for the femur, and an augment was used in the acetabulum