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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

INTRODUCTION: The ability to properly perform total hip arthroplasty with the least possible disruption of the surrounding soft tissues offers opportunities for improved hip joint stability, reduced trauma to surrounding muscles, reduced pain, and potentially achievement of a higher level of function than can be achieved with greater soft tissue dissection. The superior hip technique was developed with the goal of minimizing soft tissue dissection without compromising any of the fundamental principles of hip arthroplasty. The technique involves exposing the hip joint through an incision in the superior capsule, posterior to the medius and minimus, and anterior to the short rotators and posterior capsule. The femur is prepared in situ, the neck is transected, and the head is removed without dislocation. The cup is prepared with angled instruments and following component implantation, the capsule is closed anatomically from the acetabular rim to the shoulder of the femoral component. Rehabilitation is performed without restriction.

RESULTS: Now with well more than a decade of clinical experience in 1950 patients, results demonstrate the following(1):

1) Dislocation rate of 0.15% (3 in 1950);

2) Acute deep infection rate of 0% (0 in 1950);

3) Universal applicability: used in 99.7% of primary THA;

4) Lateral femoral cutaneous nerve palsy incidence: 0/1950;

5) Femoral nerve palsy incidence: 0/1950;

6) Transient peroneal palsy incidence: 2/1950;

7) Length of stay mean (since 2010): 1.55 days;

8) 90-day cost (2/13 to 2/14) compared to other exposures in CMS patients in the same institution: $24.200 vs. $30,100 (p<.001); and

9) Readmission costs (CMS 2/13 to 2/14) at 90 days: $0. Clinical results demonstrate that the superior hip approach for total hip arthroplasty is an attractive alternative to the many surgical techniques established for this procedure.

Economic data demonstrate significantly reduced total cost compared to the cohort of procedure performed at the same institution at the same time, suggesting that surgical technique may be a variable to consider when developing valued-based care programs.

1Murphy SB. Total Hip Arthroplasty using the Superior Capsulotomy Technique. Instr Course Lect 62. 245-50, 2013.

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