Brad Peneberg, MD Arthritis and Joint Reconstruction Institute of Los Angeles Beverly Hills, CA
Would you please describe the development of the PATH® Technique by Wright Medical Technology, Inc.?
For the past six-plus years, we have taken a special interest in soft tissue preservation techniques as they apply to total hip and knee arthroplasty. I would like to take a moment to clarify, what has been referred to as the PATH® Technique and identify the fact that the PATH® Technique offers direct and with complete access to both the acetabulum and the femur. It eliminates the angular constraints that we faced with other minimally-invasive techniques, specifically posterior techniques that have attempted to use shorter and shorter incisions. The length of the skin incision, I think we all realize now, is not related to the immediate post-operative improvement that we see – it’s the preservation of soft tissue, specifically the short external rotators and specifically the fact that we no longer stretch the gluteus medius to the same extent. What this translates into is the patient’s ability in many cases, perhaps in most cases, to straight leg raise and abduct in the recovery room. Additionally, it allows many patients the ability to walk within hours of surgery, and in many cases walk unassisted.
What are your thoughts on the implants that you are currently using for the PATH® Technique?
The unique versatility of the PROFEMUR® Modular Necks and CONSERVE® big heads has allowed us to do a more precise operation, specifically with regard to leg length and offset. We can now think of balancing the hip as we have thought of balancing the knee. You may have heard in recent months about gender-specific hips, well, Wright Medical has the ultimate stature-specific hip.
Please discuss the post operative results that you have seen over the past six-plus years.
We have eliminated post-op precautions in all patients because of a combination of soft tissue preservation, and more recently the big heads; however, even before we started using the big heads, the ability to identify and adjust the stability during surgery has allowed us to eliminate precautions and achieve a dislocation rate of zero. This is in contrast to other reported dislocation rates using minimally-invasive techniques of 0.5% to 3.0%, including the anterior approach. It has been said that the significant amount of improvements in early functionality may relate to the use of local anesthetic and steroid injections. Yes, this may reduce some of the immediate post-op discomfort, but it is hard for me to understand how that relates to reduced blood loss and improved muscle functionality using soft tissue preservation techniques.
Please discuss any final thoughts that you may have in regards to the PATH® Technique.
There clearly has been a paradigm shift in total hip arthroplasty. We have moved from a time when total hip replacement meant days of pain and suffering, weeks of severely limited activity and function, with restricted movement to reduce the dislocation rate, and months of rehabilitation to achieve and optimal result, to what we have today. We now have a time when a patient can be out of bed within hours of surgery, walking unassisted and back to work and driving within days to weeks.