ista 2007 program at a glance

A6-3
PERCUTANEOUSLY ASSISTED TOTAL HIP ARTHROPLASTY (PATH): A LESS
INVASIVE TECHNIQUE
Author: W. Seth Bolling, Michele Riley, Jason Snibbe
120 South Spalding Drive #400, Beverly Hills, CA 90212
Phone: 310-860-3470 Fax: 310-659-2724
E-Mail: shells1016@gmail.com
Introduction:
We have developed and evaluated a new posterior approach for less invasive total hip arthroplasty. Tendon attachments
are preserved, while maintaining excellent visualization and access. This paper will describe the technique
and present clinical results.
Methods:
The first 250 patients were followed prospectively for a minimum of 2 years. The new technique requires release
of only piriformis or conjoined tendon. Specially designed retractors, cup holder/alignment guide, and reamer
driver are used. Acetabular reaming and impaction are carried out through a distally placed 1cm “portal.”
Acetabular reamers are powered by the very low profile 8mm drive shaft to preserve visualization and control.
Careful, selective reaming is then accomplished by “steering” the femur.
Results:
Mean incision length was 8.3 cm. Harris Hip scores improved from 48.9 preoperatively to 95.5 postoperatively.
EBL averaged 227 cc per hip with an 8% transfusion rate. Component positioning was within recommended parameters
in 96% of patients. There were no dislocations, nerve injuries, or wound problems. Hospital stay averaged
three days.
Discussion:
Compared to reported MIS THA results, the new tissue-preserving PATH technique provided better results with a
shorter hospital stay, less bleeding, and fewer transfusions. Our clinical and radiographic results are comparable to
those reported for traditional THA techniques, but with fewer complications. We have found no increased risk of
component malposition, dislocation, or other adverse effects. Also, we believe this technique has a shorter learning
curve than previously described techniques for less invasive THA.
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