Re Superpath.
There are patents out there so there might be some licensing fees. I doubt they are a reason to use Superpath or not.
Even though my surgeon (Jimmy chow) is the primary inventor of that approach, he and I both agree that if the choice is between someone who does Superpath but has only done a handful of them and someone who has done hundreds or thousands of posterior replacements (the oldest method), go for the experienced surgeon. Muscle memory and surgical skill are critical.
There may be more but I am aware of five current methods: posterior, anterior, superpath, supercap and STAR. The last three are all somewhat variants of each other.
I would not go to a surgeon who uses multiple methods. Even with robots (mine exclusively uses a robot) I would want someone whose extensive successful experience is with a particular method.
It would be interesting, however, to ask your surgeon. I asked mine when we were chatting one day about Jiffy Knee (a friend of mine is scheduled for a Jiffy Knee replacement in December) and he said that Jiffy Knee was fine but everything depended upon the surgeon. He asked me who my friend's surgeon was. I told him it was Timothy Kavanaugh. He said that he has not seen any problems with Kavanaugh's work. My point is that my surgeon is confident enough of his own work to be willing to praise another. If your surgeon went into a lengthy discussion of the various approaches and advantages and disadvantages, that would be good.
Here is some information on Superpath:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10759432/#:~:text=of%20the%20study.-,Conclusion,the%20impact%20of%20its%20shortcomings.
This is the most recent study I have found. Note that there is no indication that the ultimate outcome is better or worse using Superpath. The advantage over more traditional methods is the speed of recovery and pain during recovery.
If you are able to find someone who is very experienced in Superpath, I would recommend going to that surgeon. But if the choice is between someone who has just started doing Superpath and someone who does and is very experienced in the Anterior approach, I would recommend going with the latter.
Hi Steve and thanks for all this info.
It's true, good surgeons are not concerned with losing business. If anything, the best are scheduling visits out 3 months and surgeries out 6 months. That's been mostly true for my knee surgeon and shoulder surgeon.
Another thing I believe, and you mention part of it, a good surgeon will almost never recommend surgery as the only option. It was my knee surgeon who explained that.
He gives his patients a range of options, starting with the most conservative (RICE, for example) all the way to surgery as the last option. He talks about the pros and cons of each, but leaves the decision up to the patient.
One thing a surgeon probably won't admit to - they don't want a patient coming back feeling worse than before surgery. When I first had my knees checked out, I was bone-on-bone but with little daily pain. I wanted the surgery, but he recommend that I hire a personal trainer and get the muscles supporting the knee in top shape. As long as I was relatively pain free - he wanted me to use the time and strengthen my leg to have a better surgical outcome.
I did that, and six months later, slipped off a 2x4 balance beam about 6" off the floor (while working with my trainer - but the fall was on me!). I had incredible shooting pain starting on the outside of my left knee, radiating up my left side. After that, I couldn't sleep on my side even with a pillow between my knees. I scheduled the surgery, and immediately felt so much better afterwards.
I had my left shoulder replaced seven weeks ago, and the same thing happened. I waited until I was in daily pain, scheduled the surgery, and again, felt immediately better. (OK, with knees and shoulders, the first few weeks of recovery are tough - but doable and still with less pain.)
I would be very leery of a surgeon who went right to a recommendation of surgery. Again, the great ones don't need or want to do that. The decision is with the patient.
(I think the reality is that once a joint is bone-on-bone, replacement is inevitable, as is pain. Knowing what I know now, I would have scheduled the surgeries earlier, before I was in daily pain. But to my surgeon's point, if you're feeling fine, it's hard to appreciate what replacement can do. I only have one hip and one shoulder left that I had at birth. Once they start to cause problems, I'm getting the surgery.)
I hope that added to the discussion. And thanks again Steve for your insight into the replacement process, especially for hips. At this point, with enough surgeons skilled with anterior incisions and the SuperPATH method you described - I'd forgo a posterior or lateral incision, and avoid cutting any muscles.
Joe