Recently, I have seen an increase of the number of patients in my clinic who have hip arthritis and require hip replacement surgery. Before attending an appointment with me, they had done quite a bit of research to find hip replacement surgery without muscle or tendon damage.
In their investigations, they have read information and watched video animations for two different techniques called ‘Superpath’ and ‘MAASH’ hip replacements. Having looked into these techniques, I can see how they may minimise muscle and tendon damage – but I believe there is another option that can provide better results with less muscle and tendon damage.
Misleading information online
The online information about these techniques can be misleading, as both operations require splitting, detaching or cutting muscles or tendons.
The Superpath technique requires splitting the large gluteus maximus buttock muscle. And in certain cases, the technique also requires the piriformis tendon to be cut. Yet it is described in videos on YouTube as having little muscle or tendon damage. If cut, the tendon requires stitching to repair it at the end of the operation.
The MAASH technique involves detaching the gluteus medius muscle from the side of the hip bone. It also requires splitting of the Ilio-tibial band, a fibrous band of tissue that runs down the side of the thigh.
Whilst these two techniques may well give good clinical outcomes, they are not the most muscle and tendon sparing techniques available. if patients are looking for a true muscle-sparing hip replacement, then I believe that the Anterior Approach Muscle-sparing (AMIS) technique offers this.
About the Anterior Approach Muscle-Sparing (AMIS) technique
Since 2012 I have been routinely using the Anterior Approach Muscle-sparing AMIS surgery with very successful outcomes. It is a true inter-nervous and inter-muscular approach to the hip. This means that no muscles or tendons are split, cut, divided or detached, unlike the Superpath and MAASH techniques. Muscles are mobilised and pushed aside, allowing access to the hip joint. After the hip replacement surgery has been finished, these muscles simply return to their original location. There is no sign of muscle damage. No muscle is at risk of losing its nerve supply (denervation).
Benefits of the AMIS technique
There are numerous other benefits to the AMIS technique. The operation is performed with the patient lying on their back rather than on their side, which my anaesthetic colleagues tell me makes the patient’s ‘airway management’ more straightforward. This also makes using an X-ray machine during the operation easier, which I routinely use during the surgery to help align and fix the implants in the right position.
The AMIS technique can also reduce postoperative pain, allow earlier mobilisation after surgery and may reduce the required length of stay in hospital. By avoiding muscle and tendon damage, the technique may also help reduce the risk of dislocation after hip replacement surgery.
For all the above reasons which align with Total Orthopaedics’ holistic ethos, I recommend AMIS hip replacements for the majority of my patients.