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Link
http://www.hips4fastrecovery.com/surgeonstories/penenberg.asp
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.
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