The Super PATH Hip technique is a tissue sparing approach to hip replacement that uses a superior approach along with a special portal to assist in placement of the socket implant. Dr. Parsons has performed several hundred SuperPATH procedures resulting in a more refined and muscle sparing technique called the SPAIRE PATH.
In a SuperPATH procedure, the piriformis tendon must be released in a majority of cases to provide sufficient access for implant placement. The obturator internus tendon is also frequently released. These are important muscles for hip stability and to provide better position sense and joint control after the replacement. While they can be repaired to the anterior capsule at the end of the case, it is difficult to repair them in a true anatomic fashion.
In a direct anterior total hip replacement, the anterior and posterior capsule and obturator internus muscle are released to expose the femur for implant placement. While the anterior capsule may be sutured closed in some cases, the posterior capsule and obturator internus are never repaired. If there is any damage to the hip abductor tendons such as a partial or full thickness tear, these cannot be visualized through an anterior approach.
SPAIRE stands for Spare Piriformis And Internus Release Externus. It is a muscle and capsule sparing approach that the releases only a small portion of the external rotator muscles and capsule while keeping the important piriformis and obturator internus attached anatomically. This approach utilizes the portal assistance of the SuperPATH to allow a less invasive approach with a smaller incision. It requires no release of the superior, anterior or inferior capsule and at the conclusion of the case, the small amount of muscle and capsule that is released can be anatomically repaired so there is complete anatomic restoration of the native soft tissue envelope around the hip replacement.
Of all of the approaches I have used over the past 20 years, in my opinion, this adaptation of the SuperPATH is the most tissue sparing of all and results in immediate stability, less protection against leg lengthening and a more natural feeling hip when it is healed. This approach can be used in any hip regardless of diagnosis and is particularly well suited to patients with larger body habitus for whom other approaches can be difficult. It allows for smaller incisions and progressive return to activities as tolerated. Once healed, Dr. Parsons lets patient resume any desired activity with no restrictions. Resumption of full unrestricted activities that require impact (running, pickleball, basketball) or have risk for collision or fall (skiing, hockey) is generally allowed at 3 months. This ensures that the implant is full integrated into the patients bone with no risk of implant loosening.
