Getting a hip replacement in South-East Asia can feel overwhelming. Hospitals vary in standards, costs are generally lower than in Europe or North America, and language or cultural differences can complicate communication. I want to share my experience exploring the SuperPATH technique — a modern, muscle-sparing approach — and what I learned about preparing for surgery, understanding risks, and thinking through recovery.

SuperPATH, which stands for Supercapsular Percutaneously Assisted Total Hip, is a minimally invasive approach designed to protect the major muscles around the hip. Instead of cutting through gluteal muscles or short external rotators, the surgeon works through a small incision at the top of the thigh. The capsule is opened, the femur is prepared while the joint is still in place, and implants are inserted through this narrow window. The components themselves are standard hip replacements; what makes SuperPATH different is the route the surgeon takes to get them in. In theory, this results in less muscle trauma, less pain immediately after surgery, and a quicker early recovery.

Not everyone is a good candidate. People with primary osteoarthritis or avascular necrosis and reasonably normal anatomy are the ideal patients. Good bone quality helps, because the corridor for instruments is narrow. Very stiff hips, major deformities, previous fractures, or high body mass can make SuperPATH less safe, and in those cases the surgeon may need to use a standard posterior or anterior approach. I personally saw a surgeon in Saigon who simply said that if I can stand on one leg, then all is good. I had an MRI with me but he couldn’t be bothered to look at it, so I’m not sure.

Expected outcomes with SuperPATH, once the surgeon is experienced, are comparable to traditional approaches. Early recovery tends to be faster, with patients walking sooner, spending fewer days in hospital, and experiencing less pain in the first few weeks. Long-term durability is determined by the implant itself, so SuperPATH does not compromise the longevity of the replacement. However, every surgery carries risks. Infection, blood clots, nerve injury, dislocation, and leg length differences are possible with any hip replacement. SuperPATH introduces the additional consideration that the small incision can make it harder to see the bone clearly. Forcing instruments through the narrow corridor can sometimes lead to a crack in the femur, especially in thin or weakened bone. Surgeons manage this by switching to a wider exposure if needed; a small fracture can often be fixed immediately with a metal band or cable, while larger fractures may require a longer stem or plate and screws. Weight-bearing may be limited for a few weeks in either case.

Conversion to a wider approach is a standard safety measure. Posterior is usually the backup because it allows clear access without repositioning the patient, although anterior or lateral conversions are technically possible but rare. Abandoning the operation midway is generally unsafe due to bleeding, infection, and instability risks. I don’t fully understand this to be honest but I think perhaps it means that once they realise they don’t have the visibility, then they’ve already started some of the work and perhaps damaged the bone? No idea. However, most surgeons will not start unless you accept that they may need to convert if visibility or bone quality prevents safe completion.

Leg length is another common concern. Standing X-rays before surgery help measure true differences, accounting for pelvic tilt and spinal curves. Intra-operatively, surgeons set a marker in the pelvis before cutting the bone and check trial and final components against it, adjusting the head or neck size if needed to achieve equal length. This careful approach reduces the likelihood of noticeable differences after surgery.

Recovery after SuperPATH often starts the day of or after surgery, with patients standing and taking a few steps using a frame or crutches. Many can progress to a stick within a week or two, performing light daily tasks while avoiding deep bending or lifting. Exercises for the gluteal and abductor muscles begin once the wound is stable. Driving is generally permitted once you can safely operate the vehicle, typically four to six weeks post-op. Low-impact activities such as swimming or cycling may follow after scar healing, but running and jumping are discouraged. With proper placement and careful use, a replacement can last 15–20 years or more.

Finally, preparing for surgery also means asking the right questions. Here is a checklist I recommend for any patient considering SuperPATH:

• How many total hip replacements have you done, and how many using SuperPATH?
• How often have you had to convert to another approach, and which approach do you use?
• What are your rates of infection, fracture, dislocation, or nerve injury?
• How many of your patients have needed a revision, and after how long?
• Will you personally review my MRI or X-rays before surgery?
• What is your plan if visibility is poor or the bone looks fragile during surgery?
• Which implant brand and model do you use, and why (although when I asked this previously he didn’t know (two differnt doctors))?
• How do you prevent infection and blood clots?
• How do you check leg length during surgery?
• Who oversees rehabilitation and aftercare?

By addressing these questions and understanding the procedure, risks, and recovery, patients can make informed decisions and approach hip replacement surgery with confidence, even in a foreign healthcare system.