Supercapsular percutaneously assisted (SuperPath) approach in total hip arthroplasty

Abstract

ObjectivePortal assisted minimally invasive total hip arthroplasty without dislocation of the femoral head with preservation of the hip capsule and the external rotators in the lateral decubitus position for rapid recovery with the option of expandability to a mini posterior or classic posterolateral approach at any time.IndicationsPrimary and secondary arthritis of the hip, femoral head necrosis, femoral neck fracture.ContraindicationsSevere anatomical disorders of the proximal femur, congenital high hip dysplasia, implanted hardware in the trochanteric region, local and systemic infections.Surgical techniqueLateral decubitus position, skin incision of 6–10 cm from the tip of the greater trochanter in line with the femoral axis, spread gluteus maximus, using the interval between the piriformis tendon posterior and gluteus minimus/medius muscle anterior, incision of the capsule, remove bone of the lateral neck and head, intramedullary reaming and broaching of the femur, osteotomy of the femoral neck with the femoral broach left in situ, remove the femoral head, preparation of the acetabulum using a cannula posterior of the femur, cup impaction and implantation of the inlay, trial modular neck and head, reposition, test of leg length, impingement and stability, x‑ray, implantation of the definitive components, closure of the capsule, standard wound closure.Postoperative managementFull weight bearing as possible, no restrictions of postoperative movement.ResultsThe first 150 patients were operated from January 2016 to July 2017 without leg length discrepancy more than 5 mm; one transfusion was needed. There were two subluxations, one wound dehiscence and one femoral diaphyseal fracture 4 weeks after surgery. There was no radiological loosening of the components after a mean of 16 months.

Comparison The Early Clinical Efficacy of SuperPath Approach Versus The Modified Hardinge Approach In Total Hip Arthroplasty For Femoral Neck Fractures In Elderly: A Randomized Controlled Trial

“…The SuperPath approach retains the muscles around the hip joint such as the external rotation muscle group, piriformis muscle, gluteus minor muscle, and gluteus medius muscle, ensuring the integrity of the front and rear of the hip capsule [33]. The surgery uses in situ resection of the femoral neck and femoral head instead of dislocation of the hip joint, so it has the characteristics of less trauma and high safety [20]. Meng et al prospectively analyzed the level of CK and in ammation after THA in SuperPath approach, and found that the levels of all serum markers in the SuperPath group were still relatively higher than those in the PLA group at all times [29].…”

“…In 2011, Dr. James Chow rst reported the supercapsular percutaneously assisted total hip (SuperPath, MicroPort Orthopedics Inc., Arlington, TN) approach, which combines the advantages of the supercapsular (SuperCap, MicroPort Orthopedics Inc., Arlington, TN, USA) approach and the percutaneously assisted total hip (PATH, MicroPort Orthopedics Inc., Arlington, TN, USA ) approach [15]. The SuperPath technique reaches the hip joint capsule through the tissue gap between the gluteus medius and the piriformis, so this technique reduces need for cutting muscles and tendon to protect the external rotator muscle [19,20]. Previously reported that SuperPath technology has shown that the time to go to the ground is shortened, the hospital stay is short, the incidence of complications is low, and the in-hospital cost is low [21,22].…”

Less blood loss in supercapsular percutaneously assisted versus posterolateral total hip arthroplasty

“…The common exclusion criteria were as follows: active infection; tumors; and hematologic diseases, such as blood coagulation disorders, thrombocytopenia, and other hemorrhagic disorders. The additional exclusion criteria for SuperPath were as follows: severe deformation of the proximal femur; congenital high hip dysplasia; and osteosynthesis of the proximal femur [ 15 ]. Variables, such as gender, age, height, weight, BMI, diagnoses, affected side, pre- and post-operative radiographic findings, pre-operative hemoglobin (Hb) concentrations, pre- and post-operative hematocrit (Hct), operative time, and transfusion blood volume were recorded.…”

The Supercapsular Percutaneously Assisted Total Hip (SuperPATH) Approach Revisited: Technique Improvements after the Perioperative Experience of 344 Cases

“…While performing the SuperPATH approach, we followed exactly the steps described by Chow [ 13 ]. There have been papers that describe various aspects of the initial technique in detail such as the placement of the acetabular cup [ 14 , 15 ]. Quitmann [ 14 ] describes the use of a guidance tower for placing the acetabular cup, while Della Torre et al [ 15 ] point out the importance of the transverse acetabular ligament.…”

“…If the broach was as deep in the femur as planned preoperatively, we proceeded to the neck cut using a double-sided blade. The cut was made using the proximal end of the broach for guidance [ 14 ]. The next X-ray was taken after the trial reduction of the hip.…”