Direct Superior approach
Superior soft tissue preservation
Procedural overview
Direct Superior approach is an iliotibial band and muscle-sparing surgical approach to the hip that offers the potential benefits to the patient of faster recovery,1,2 less pain1,2, and greater satisfaction.3 The Direct Superior approach and its proprietary instrumentation, including a tissue-friendly retractor and unique acetabular reamer, were designed for surgeons who prefer the fundamentals and familiarity of the more traditional posterior approach but seek to provide the next evolution in muscle-sparing THA surgical techniques for their patients. This approach was designed to be used with a variety of Stryker’s cementless femoral stem options, given the excellent exposure and access to the femoral canal.
The Direct Superior approach helps minimize trauma to soft tissue, muscle, and tendons that are critical to the functionality of the hip.4 Most noteworthy are the preservation of the iliotibial band, distal external rotators, including obturator internus, and abductors. There are potential clinical benefits to the Direct Superior approach, such as enhanced hip stability and postoperative recovery.4,5,6 Additionally, the approach is extensile, if necessary, which offers options during surgery in the event of unexpected challenges requiring greater surgical exposure.4 And unlike some other muscle-sparing surgical approaches, the Direct Superior approach does not require the use of a specialized surgical table. The table below illustrates some potential benefits of the Direct Superior approach compared to the traditional approach.
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Implants
Femoral
Insignia®
The Insignia hip stem leverages more than 1,300 CT scans, utilizing a 3D modeling and analytics system, Stryker Orthopedic Modeling and Analytics (SOMA) bone database, and is engineered to optimize fit and function. Founded on Stryker’s signature principles of implant fit, Insignia® is your collared, metaphyseal-filling hip stem designed specifically for muscle-sparing approaches.
Accolade II
Morphometric wedge femoral stem, an evolution of your conventional tapered wedge stem that is SOMA-designed for today’s diverse THA patient population.
Exeter
The Exeter cemented femoral hip system is designed for surgeons who are looking to perform all hip indications - primary, revision and fracture - with a single proven system.
Restoration® Modular
Make the most of your revision cases with a clinically-backed platform that is designed to leverage versatility and simplicity to help you achieve desired revision THA outcomes.
Acetabular
Trident II
Have confidence in a powerful combination–a system that builds on the legacy that has defined our Trident brand for more than two decades, paired with the latest additive manufactured Tritanium In-Growth Technology or PureFix HA.
Modular Dual Mobility
Modular Dual Mobility is a premium acetabular offering designed to help prevent dislocation. The system builds upon our Anatomic Dual Mobility offering by providing you a choice of fixation surfaces and screwhole configurations for primary or revision THA.
Instrumentation
Designed to maximize visibility while minimizing soft tissue damage
Meet the latest tools in our exclusive Direct Superior approach instrument set.
Our high offset reamer handle and specialized instruments are designed to help facilitate acetabular and femoral exposure along with bone preparation.
The Direct Superior approach retractor and reamer set features downsized retractors with longer arms designed to increase visualization within the surgical field.
Mako Total Hip
Elevating total hip proceduresThe Direct Superior approach is compatible with Mako SmartRoboticsTM for primary procedures, marrying this minimally invasive approach with today’s latest technology in functional hip alignment.
Enhance your surgical approach with Mako Total Hip through:
- CT-based 3D modeling and elevated planning features, Mako Total Hip provides unprecedented information with the goal of helping surgeons enhance patient outcomes.8
- Patient-specific planning to enable more accurate implant positioning to plan.9
- Surgeons can visualize potential impingement by looking at the changes to their patient’s pelvic tilt in the sitting, standing, and supine positioning to plan.10
- Using AccuStop™ haptic technology and a patient-specific CT scan, Mako Total Hip enables single-stage reaming and guided cup impaction to help promote accurate implant placement to plan.10
Learn more through these resources
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References:
- Restrepo C, Parvizi J, Pour AE, Hozack WJ. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty. 2010;25(5):671-9.e1. doi:10.1016/j.arth.2010.02.002
- Vail TP, Mariani EM, Bourne MH, Berger RA, Meneghini RM. Approaches in primary total hip arthroplasty. J Bone Joint Surg Am. 2009;91 Suppl 5:10-12. doi:10.2106/JBJS.I.00343
- Zawadsky MW, Paulus MC, Murray PJ, Johansen MA. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty. 2014;29(6):1256-1260. doi:10.1016/j.arth.2013.11.013
- Roger DJ, Hill D. Minimally invasive total hip arthroplasty using a transpiriformis approach: a preliminary report. Clin Orthop Relat Res. 2012;470(8):2227-2234. doi:10.1007/s11999-011-2225-z
- Penenberg BL, Bolling WS, Riley M. Percutaneously assisted total hip arthroplasty (PATH): a preliminary report. J Bone Joint Surg Am. 2008;90 Suppl 4:209-220. doi:10.2106/JBJS.H.00673
- Khan RJ, Fick D, Khoo P, Yao F, Nivbrant B, Wood D. Less invasive total hip arthroplasty: description of a new technique. J Arthroplasty. 2006;21(7):1038-1046. doi:10.1016/j.arth.2006.01.010
- American Academy of Orthopaedic Surgeons. Treatment: Minimally Invasive Total Hip Replacement. https://orthoinfo.aaos.org/en/treatment/minimally-invasive-total-hip- replacement/. Accessed 9 May 2023.
- Bukowski BR, Anderson P, Khlopas , Chugtai M, Mont MA, Illgen RL. Improved functional outcomes with robotic compared with manual total hip arthroplasty. SurgTechnol Int. 2016;29:303-308.\
- Domb B, Redmond J, Louis S, Alden K, Daley R, LaReau J, et al. Accuracy of component positioning in 1980 total hip arthroplasties: a comparative analysis by surgical technique and mode of guidance. The Journal of Arthoplasty. 30(2015)2208-2218.
- Domb BG, El Bitar YF, Sadik AY, Stake CE, Botser IB. Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res. 2014;472(1):329-336. doi:10.1007/s11999-013-3253-7
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