Beginning with the father of the modern THA, Sir John Charnley and continuing into the present with advances in approaches, materials and methods, much has changed.  Some of the earliest hips placed a glass cup over the head of the femur to “resurface” the worn joint in patients suffering from the effects of tuberculosis.  As you might imagine, these didn’t last long.  Successive iterations evolved to place a metal stem into the femur with a ball on the end to act as the removed femoral head.  These were an improvement, and the precursor to the hemiarthroplasties we use now for fractures, but they didn’t generally last long, and the approaches used to place them were extremely invasive.  Sir John Charnley began placing cemented stems in the femur that articulated with a plastic cup that was placed into the socket of the pelvis, the acetabulum, in the 1960’s.  His approach involved making a cut in the bone, an osteotomy, of the proximal part of the femur.  This required extensive recovery time and limited weight bearing for weeks after the procedure.  Despite this, Sir Charnley’s hips have been shown in large series to last over 20 years in some cases.  Advances in materials and the introduction of coatings that allowed bone to grow onto stems and cups, and eventually ingrowth technology has led to the modern total hip consistently lasting 20-25 years.

Along with the advances of the implants came progression of surgical technique.  In the early stages of “press fit” components, the Posterior Approach was widely used and still is today.  In the 1980’s and into the 1990’s it was the most common approach for a total hip.  If done properly in conjunction with a sound capsular repair, a Posterior Approach will result in excellent function and low risk of dislocation.  But, historically, the PA was thought to have a high rate of instability.  For this reason, several surgeons pioneered the use of the Anterior Approach.  As the name implies, this approach gains access to the hip from the front.  It generally has a low risk for dislocation.  But, it can be technically challenging to perform, requires the use of special instruments and tables, as well as live x-rays during surgery.  It is also not generally used in patients with a large abdomen because it make the exposure difficult and increases risk for wound problems.  The biggest negative I see with the anterior approach involves exposure of the femoral neck that often requires resection of a large portion of the Capsule. Despite these drawbacks, the anterior approach has gained traction over the last 10 years and is highly promoted and supported by industry. 

A less common approach was pioneered in the early 2000’s by Boston surgeon, Dr. Stephen B. Murphy.  He was looking for a way to limit the soft tissue dissection in a total hip while still ensuring accurate component placement.  Through extensive research Dr. Murphy concluded that the only way to ensure accurate component placement while limiting exposure during a total hip was to incorporate technology into the surgery.  His efforts led to the creation of the Superior Capsular Approach and the Hip Xpert. 

The Superior Approach is aptly named.  I have used it extensively since 2016 with outstanding results.  The benefits of the superior approach include early mobilization, no need for special tables, no dislocation of the hip during surgery, limited dissection, a smaller incision, essentially eliminates hip instability and most appreciated by patients - less pain and no hip precautions.  This last item is a paradigm shift in total hips.  What makes this possible is the Hip Xpert.

The Hip Xpert is a mechanical navigation device that is used during the surgery to ensure accurate cup placement.  It has been shown in multiple studies that cup malposition has more to do with total hip failure that all other causes.  Furthermore, studies have shown that cup placement can be outside of the “safe zone” in up to 40% of cases done using traditional cup alignment techniques.  The Hip Xpert system removes this possibility by guiding cup placement during the surgery.

To begin, a patient undergoes a low radiation CT scan of the pelvis.  The data from the study is then loaded onto the Hip Xpert Server and we are able to plan the cup placement on a 3D model of a specific patients pelvis.  Essentially, doing the surgery virtually, prior to any skin incision.  At the time of surgery, data from the cup position in the Hip Xpert software is transferred onto the Hip Xpert Device, which is docked onto the patients pelvis and used to align the cup prior to fixation.  This process allows me to make a smaller incision, eliminate stripping the muscle off the back of the hip, while ensuring your hip will be stable, and give you the years of pain relief we are looking for.  I am the only surgeon in the region offering this approach to my patients and my results have been very rewarding.  Patients are encouraged to walk the day of surgery.  Average length of hospital stay is just at 24 hours, thus reducing costs.  And, physical therapists and nurses alike have remarked at the difference in my patients compared to my colleagues. 

The benefits of using the Hip Xpert system in conjunction with a Superior Approach are many.  But, this is not an easy or common thing to do.  If you would like to utilize this approach for your total hip, there is a fee of $1800 for the surgical planning.  This is outside of your medical insurance and deductables.   We ARE able to get most insurance companies to cover the cost of the device rental, CT scan, and data submission.   If you choose not to use the Hip Xpert System, we will still provide you with exceptional surgery and your pain relief and return to function will be predictable.  However, this will require a bigger surgery to make sure your components are properly aligned. 

I hope this letter gives you the confidence to move forward with Hip Xpert.  I look forward to discussing your case in detail and answering any questions you have.

Sincerely,