Total hip replacement is by far one of the most successful surgical procedures, transforming the lives of people living with pain and disability due to hip arthritis. Good to excellent patient satisfaction have been reported in the orthopaedic literature within the range of 90—95%. International and Australian joint replacement registries report total hip replacement longevity for the widely used implant combinations often better than 95% at 15 years or more with no obvious indications that we are nearing the point that the bearing surfaces have reached the end of their lifespan.
Total hip replacement surgery has come a long way since inception. Implants better match patient anatomy, the moving parts are more durable and the way surgeons access the hip – the ‘approach’ – are becoming less invasive. The goals of hip replacement remain the same: restore function and alleviate pain but hip surgeons are now focusing on improving accuracy, restoring function sooner, minimising post operative discomfort and reducing risk of a complication.
One such concept to improve outcomes rather than just making the length of the incision smaller (the so called ‘mini approaches’) is the concept of tendon sparing approaches. These approaches are generally less invasive and do not violate important pelvic stabilisers and tend to convey earlier pelvic stability and comfort. Hip precautions are generally not necessary after surgery. One of the more recent advances is the ‘Direct Superior Approach’. This approach is a well thought out modification of a well known and durable posterior approach for hip replacement that many hip surgeons prefer. It takes the best elements of this well known and safe approach but spares the important hip stabilisers without making the surgery more technically demanding. The benefits for patients are earlier return to function and no requirement for ‘hip precautions’ or a list of leg movements your surgeon will ask you avoid after surgery in the early post-operative period. The benefits for surgeons are safe and reproducible results without compromising patient safety or altering the use of tried and tested implants with a good long term track record.
As always, the best approach will always be the approach your surgeon is most comfortable to achieve the best short and long term results following hip replacement surgery.
Dr Jason Tsung has been using the direct superior approach since early 2017 as his preferred approach for hip replacement and is one of only a handful of surgeons within Australia rigorously trained in this approach. He is actively involved in training this approach both locally and abroad.