Supercapsular percutaneously-assisted total hip (SuperPath) versus mini-incision posterolateral total hip arthroplasty for hip osteoarthritis: a prospective randomized controlled trial

Abstract

Background: Supercapsular percutaneously-assisted total hip (SuperPath) arthroplasty has been proposed to be minimally invasive and tissue sparing, with possible superior postoperative outcomes compared with conventional approaches for total hip arthroplasty (THA). However, previous studies have underlined the shortcomings of conventional THA approaches, including higher dislocation, more blood loss, longer incisions, more tissue damage, and delayed postoperative rehabilitation. In the present study, we compared the short-term outcomes of unilateral THA with those of SuperPath and the mini-incision posterolateral approach (PLA) for hip osteoarthritis (OA). Methods: Patients with unilateral hip OA were prospectively recruited and underwent either SuperPath (SuperPath group) or mini-incision PLA THA (PLA group). Perioperative status [operative time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay (LOS)], and postoperative function outcomes, including range of motion (ROM), pain visual analog scale (VAS), and Harris Hip Score (HHS), were evaluated and compared between the groups at scheduled time points within 12 months postoperatively. Results: Compared with the PLA group, the SuperPath group yielded a significantly shorter incision length (7.83 vs. 12.45 cm, P<0.001), longer operative time (102.72 vs. 66.22 min, P<0.001), more blood loss (1,007.38 vs. 844.55 mL, P=0.005), and more soft tissue damage (creatine kinase: 1,056.05 vs. 821.50 U/L, P=0.006) on postoperative day 3. The SuperPath group also showed deficient acetabular cup positioning (abduction angle: 36.94° vs. 42.66°, P=0.004) and a greater decrease in ROM (flexion: 107.66° vs. 114.44°, P=0.004; 109.83° vs. 116.11°, P=0.002; 111.66° vs. 118.88°, P<0.001) on postoperative days 1, 3, and 14, aswell as severe early-term pain symptoms (pain VAS on postoperative day 3: 7.05 vs. 6.55, P=0.041). However, the LOS, C-reactive protein levels, erythrocyte sedimentation rate (within 2 weeks postoperatively), and HHS were comparable between the groups during the 12 months postoperatively.Conclusions: SuperPath may be a promising, minimally invasive technique for the treatment of OA in the future. Further investigation is necessary to evidence the possible superiority of SuperPath over other conventional mini-incision THA approaches.

Supercapsular Percutaneously-Assisted Approach Versus Conventional Posterolateral Approach For Primary Total Hip Arthroplasty: A Prospective Randomized Controlled Trial

“…One of the advantages of minimally invasive surgery is that it can reduce the muscle and soft tissue impairment.In previous studies, SuperPATH approaches are correlated with lower levels of in ammation markers comparing with standard approaches [12].However,a recent study demonstrated that the SuperPATH group unexpectedly yielded more soft tissue damage and signi cantly increased serum CK levels compared with the PLA group on day 3 postoperatively [13].In our study, no difference was found concerning the increase of serum CRP,CK and ESR levels between the two groups.These inconsistent results are possibly attributable to additional intraoperative soft tissue (mainly muscle) damage from many sources , including intraoperative stretching , unintentional detachment , and varied instrument retraction , during the signi cantly elongated time taken to perform the procedure.A cadaveric model study by Amanatullah et al showed that the piriformis-sparing posterior approach to the hip causes inadvertent damage to the piriformis muscle in >90% of cases and that this damage occurs outside of the surgical eld [14].…”

“…Previous studies had con rmed that the VAS score were lower and HS was higher in the SuperPATH cohort comparing to the conventional approach in the early operative phase [20].Our study also con rmed the same results.However,the meta-analysis by Ramadanov found that no differences in pain VAS between hip replacements via SuperPATH and conventional approaches 1, 3 days, 3 and 12 months postoperatively [7].On the contrary,Meng et al [13] found that pain VAS was signi cantly higher in the SuperPath group (7.05) compared with the PLA group (6.55) on postoperative day 3 and remained comparable between both groups at other time points within 1 year postoperatively.The meta-analysis by Ramadanov reported that HS on 7 days postoperatively was 10.2 higher in hip replacement via SuperPATH approach compared to hip replacement via conventional approaches [7]. Meng et al [13] reported that differences in average HHS were not signi cant between the PLA groups and SuperPath groups at any time point,hip function was observed to be signi cantly improved on postoperative day 14 (70.66±6.22) in the PLA group, but only showed a signi cant improvement at 3 months postoperatively (82.44±3.51) in the SuperPath group. Their data indicated that SuperPAHT was associated with overall inferior patient-reported outcomes during the early postoperative phase in terms of pain symptoms and hip function.…”

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

“…Controversies exist over the precise definition of a minimally invasive approach, as no clear definition is reported [ 22 , 41 , 48 ]. The SuperPath technique fits into the group of minimally invasive muscle-sparing techniques, since it preserves the cutting of the extrarotator muscles, hip joint capsule, and avoids surgical dislocation of the femoral head [ 46 ]. Several studies report benefits related to this technique [ 22 , 23 , 47 , 49 – 51 ].…”

Radiographic Results on Acetabular Cup Placement with the SuperPath Technique: A Retrospective Study of 756 Cases

“…Controversies exist over the precise de nition of a minimally invasive approach, as no clear de nition is reported [22,37,45]. The SuperPath technique ts into the group of minimally invasive muscle-sparing techniques, since it preserves the cutting of the extrarotator muscles, hip joint capsule, and avoids surgical dislocation of the femoral head [43]. Several studies report bene ts related to this technique.…”

“…Few studies have evaluated acetabular cup placement depending on the surgical approach [29,[39][40][41]. MIS techniques arose with the simultaneous effort to reduce periarticular tissue damage and achieve good clinicalradiographic results, the latter at least overlapping with those obtained with traditional surgical approaches [42][43][44]. In this regard, it would also be appropriate to clarify the correct de nition of MIS, since the surgical approaches are manifold and different from each other.…”