Radiographic results on acetabular cup placement with the SuperPath technique: a retrospective study of 756 cases

Abstract

Background The Supercapsular percutaneously assisted total hip (SuperPath) technique is a relatively new minimally invasive approach for total hip arthroplasty (THA). Good clinical outcomes related to its use are reported in the literature. Nonetheless, there are still uncertainties about its validity in terms of radiographic outcomes. Main purpose of the study is to evaluate the effectiveness of the SuperPath in acetabular cup positioning through radiographic evaluation of acetabular inclination angle (IA) and acetabular anteversion (AA) angle within the safe zone described by Lewinnek. The leg length discrepancy (LLD), femoral offset (FO), and acetabular offset (AO) were also measured to ascertain the radiographic effectiveness of SuperPath in the acetabular cup placement. Methods Between January 2016 and December 2019, all SuperPath cases eligible for the study were included. They were operated by three orthopaedic surgeons with long-standing experience in THA via conventional posterolateral approach and who have performed SuperPath training fellowship. The Mann-Whitney U test was used for statistical assessments (p-value < 0.05). Means ± standard deviation (SD) of the radiographic IA and AA were calculated for each year. Results A retrospective analysis of 756 THAs was performed. The average percentage of IA within the Lewinnek’s safe zone was from 80 to 85%, while the average percentage of AA was from 76 to 79%. Both IA and AA showed no statistically significant difference between two consecutive years. Good results, in the ranges of normal values, were also obtained for LLD, FO and AO, with homogeneous outcomes between 1 year and the following one. Conclusion It is possible to achieve good radiographic values of acetabular cup orientation through the SuperPath within the Lewinnek’s safe zone. These results are similar to those reported in the literature by authors using SuperPath. Low rate (0,3%) of hip dislocations were reported. Therefore, the SuperPath technique represents a good alternative THA approach. Nevertheless, there is not a statistically significant improvement in these radiographic parameters over a four-year time. Level of evidence Level IV, retrospective study.

SuperPATH—Current Status of Evidence and Further Investigations: A Scoping Review and Quality Assessment

“…The initial search returned 55 records [ 5 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ] for further consideration. After full-text screening, 4 records [ 14 , 15 , ...…”

“…After full-text screening, 4 records [ 14 , 15 , 16 , 17 ] that used the term “SuperPath” with a different meaning were excluded. The bibliometric search with a complete inter-reviewer agreement (κ = 1.0) yielded 51 articles on SuperPATH [ 5 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ], all of which were included in the scoping review. Of those 51 articles, 9 were...…”

“…With the exception of the 2011 article [ 5 ] in which James Chow introduced SuperPATH, all other articles [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ] were published between 2015 and 2023 ( Figure 2 ). In 2015, 4 out of 51 articles (8%) were published on SuperPATH [ 42 , 54 , 55 , 67 ], while in 2...…”

Superior outcomes of total hip arthroplasty without prior lumbar arthrodesis: a systematic review and meta-analysis

“…The anterior and posterior pelvic tilting regulated the spinal configuration, which is essential to maintain the center of mass of the head and trunk directly above the legs and the position of the acetabulum over the femoral head [ 35 , 36 ]. During staying, the hip extends, the pelvis tilts anteriorly, the spine becomes more lordotic, and the acetabulum relatively comes closer to the femoral head [ 12 , 37 ]. During sitting, the hip flexion is associated with a posterior tilt of the acetabulum an average of 15°–20°.…”

CORR Insights®: The Supercapsular Percutaneously Assisted Total Hip Approach Does Not Provide Any Clinical Advantage Over the Conventional Posterior Approach for THA in a Randomized Clinical Trial

“…Next, the clinical evidence is still inadequate regarding the rates of dislocation and other complications after the SuperPATH approach is used. Although several observational studies have reported dislocation rates and cup positioning [2][3][4]6], RCTs could have underpowered the results regarding the rates of dislocation and other complications, and few comparative studies with a large number of patients have compared the complication rates of SuperPATH with the rates of conventional approaches. Future studies should do this.…”