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The Superior Approach for Total Hip Arthroplasty: Technique and 13 Years Experience

February 19, 2016

Contributors: William Murphy; Kevin Scott Borchard, MD; Anil Oommen Thomas, MD; Daniel Le, MD; Richard David Reitman, MD; Stephen B Murphy, MD; J Scott Reid, MD; J Scott Reid, MD

The ability to properly perform total hip arthroplasty with the least amount of soft-tissue disruption may improve hip joint stability, decrease trauma to the surrounding muscles, decrease pain, and result in a higher level of function than can be achieved with greater soft-tissue dissection. The superior approach to the hip was developed with the goal of minimizing soft-tissue dissection without compromising the fundamental principles of hip arthroplasty. The technique involves exposing the hip joint via an incision in the superior capsule, posterior to the medius and minimus and anterior to the short rotators and the posterior capsule. The femur is prepared in situ, the neck is transected, and the head is removed without dislocation. The cup is prepared with the use of angled instruments. After component implantation, the capsule is closed anatomically from the acetabular rim to the shoulder of the femoral component. Rehabilitation is performed without restrictions. Results of 1,950 patients who underwent the superior approach for total hip arthroplasty over the course of more than one decade include: (1) Dislocation rate of 0.15% (3 of 1,950 patients); (2) Acute deep infection rate of zero (0 of 1,950 patients); (3) Universal applicability: approach used in 99.7% of patients who underwent primary total hip arthroplasty; (4) Lateral femoral cutaneous nerve palsy rate of zero (0 of 1,950 patients); (5) Femoral nerve palsy rate of zero (0 of 1,950 patients); (6) Transient peroneal palsy rate of 0.05% (2 of 1,950 patients); (7) Mean hospital length of stay (since 2010): 1.55 days; (8) 90-day cost (2/13 to 2/14) compared with other surgical exposures in Centers for Medicare & Medicaid Services patients at the same institution: $24,200 versus $30,100 (P < .001); (9) 90-day readmission cost (Centers for Medicare & Medicare Services, 2/13 to 2/14): $0. These clinical results show that the superior approach for total hip arthroplasty is a good alternative to the many established surgical approaches for total hip arthroplasty. Economic data demonstrate considerably decreased total cost compared with the cohort in which the procedure was performed via other surgical exposures at the same institution at the same time, suggesting that surgical technique may be a variable to consider in the development of valued-based care programs.

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