Assessment of the Learning Curve of Supercapsular Percutaneously-assisted Total Hip Arthroplasty in an Asian Population

Abstract

Background: The supercapsularpercutaneously-assisted total hip (SuperPATH) approach is a micro-invasive approach that was developed to minimize surgical disruption of soft-tissue during routine total hip arthroplasty (THA). This study aimed to assess early outcomes and learning curves of the SuperPATHapproachin one Chinese hospital’s experience.Methods: Early outcomes of the first consecutive 78SuperPATH cases (80 hips) performed by same surgeon were evaluated. The patients were divided into 4 groups according to the surgical order. The incision, intraoperative blood loss, hospital stay, Harris hip score and complications occurrence in each group were evaluated. Learning curves were assessed using operative time and intraoperative blood loss as surrogates.Results:The operation time and intraoperative blood loss of group A and B was more than that of group C and D, and the difference was statistically significant (P<0.05), however there was no statistically significant difference between the two groups (group A vs. group B, P=0.426; group A vs. group B, P=0.426).There was no statistically significant difference in terms of incision length and hospital stay and Harris hip score at the last follow-up was increased with statistically significant difference when compared with that of preoperative among the 4 groups. One case of periprosthetic fracture occurred in group A. No other complication, such as joint dislocation, sciatic nerve injury, prosthesis loosening, periprosthetic infection and deep vein thromboembolism, occurred in 4 groups.Conclusion:In summary, for surgeons who familiar with the standard posterolateral approach, they could achieve more familiar with SuperPATH after 40 case of surgery.

Efficacy of Supercapsular Percutaneously-Assisted Total Hip Arthroplasty in the Elderly With Femoral Neck Fractures: A Meta-analysis

“…According to Zhang et al, 24 unfamiliarity with the surgical process and related surgical instruments might lead to no superiority of this tissue-sparing technique in terms of early pain relief, implying that the analgesic efficacy of SuperPATH was associated with the skilled operation. Besides, two previous studies focusing on its learning curve demonstrated that the operative time of the SuperPATH continued to decrease by case 50 12 and by case 40 29 , respectively, where surgeons achieved more familiarity with this technique. Also, there existed relatively short length of stay and low complication rates even during the learning curve.…”

“…Based on the fact that the SuperPATH technique processes extendability to the classic posterior approach, it is recommended to convert the SuperPATH approach into the traditional method to avoid errors if failed incision minimalization occurs during the learning curve. 11,12,29 Several limitations to the present investigation should be listed: (1) a limited number of non-randomized comparative studies contributed data (collected prospectively or retrospectively) to the meta-analysis and there was insufficient data for measuring some endpoints, such as postoperative VAS (only 2-4 studies included); (2) there was inadequacy of eligible RCTs, which resulted in our weakened power to make a rigorous conclusion, and meanwhile, an unclear risk existed in most of the studies due to blind assessment of endpoints not being stated, except for 1 study 19 ; (3) the English literature available related to the SuperPATH was sparse and all our selected studies were conducted in China and almost written in Chinese, which could engender some bias in the analysis; and (4) there were relatively small sample sizes and short follow-up periods among included papers (only 1 study 24 having a 2-year follow-up), leading to a lack of comprehensive evaluation of this technique regarding its long-term effects. With the rise of this novel MIS technique, more prospective randomized comparative studies, enrolling more patients and with a long-time follow-up period, are needed to provide more robust evidence for the application of SuperPATH in THA for the treatment of elderly FNFs.…”

“…Therefore, the SuperPARH THA should be conducted with the aid of sufficient exposure to C-arm fluoroscopy and detailed plans should be established in preparation for the surgery, such as estimating the length of femoral necks and selecting the impact design. 17,24,29 Moreover, future research should document the cup and stem positioning and highlight any positioning issue such as varus stems and vertical cups during SuperPATH procedures, so as to help surgeons incorporate this innovative technique into their own practice more safely. In addition, the surgeons should equip themselves with enhanced knowledge of anatomical landmarks and enriched experience in THA surgery.…”

“…Based on the fact that the SuperPATH technique processes extendability to the classic posterior approach, it is recommended to convert the SuperPATH approach into the traditional method to avoid errors if failed incision minimalization occurs during the learning curve. 11,12,29…”

Observation of the short-term curative effect of using SuperPATH approach to treat elderly femoral neck fractures with schizophrenia

“…The occurrence of these complications may become an important cause of follow-up doctor-patient disputes 22 . Pengfei Lei et al 23 demonstrated that for surgeons familiar with the standard posterolateral approach, after 40 operations, they can become more familiar with SuperPATH.…”