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

A Systematic Review and Meta-Analysis of Supercapsular Percutaneously Assisted Total Hip Arthroplasty Versus Standard Posterior Approach for Femoral Neck Fracture in Elderly Patients

INTRODUCTION

This meta-analysis aimed to evaluate the efficacy and safety of the supercapsular percutaneously assisted total hip arthroplasty (SuperPATH) and the standard posterior approach in hip arthroplasty in treating femoral neck fractures in elderly patients.

METHOD

A systematic search was conducted for studies from 2012 to December 2022. Meta-analysis was conducted using Review Manager 5.3 on surgical time, intraoperative blood loss, Harris hip scores, and visual analog scale scores.

RESULT

A total of 26 studies involving 2,236 patients with femoral neck fractures were included. The SuperPATH group performed better than traditional posterior approach group in reducing intraoperative blood loss (in ml), shortening incision length (in cm), length of hospitalization period (in days) and improving Harris Hip score (HHS). The operation time took longer than the traditional posterior approach, with statistically significant differences. The VAS scores at 1 week and 3 months after surgery in the SuperPATH group were lower than those of the traditional posterior approach, with statistically significant differences. There was no statistical significance between the two groups in VAS scores 2 weeks and 1 month after surgery.

CONCLUSION

The SuperPATH group resulted in better effects in reducing intraoperative blood loss (in ml), shortening incision length (in cm), length of hospitalization period (in days), and improving Harris hip score (HHS), which is conducive to the rapid postoperative recovery of patients.

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

As China enters an aging society, the incidence of femoral neck fractures is increasing year by year. For some patients, total hip arthroplasty (THA) is the treatment of choice for displaced femoral neck fractures. Schizophrenia is a common combination of elderly patients with femoral neck fractures, and there are few reports on the treatment. This study describes the short-term efficacy of the supercapsular percutaneously assisted (SuperPATH) approach in the treatment of patients suffered with displaced femoral neck fractures combined with schizophrenia. A retrospective analysis of 20 elderly patients with displaced femoral neck fractures combined with schizophrenia who underwent THA using the SuperPATH approach. Record demographic data, postoperative reexamination of X-ray film to observe the position and the loosening condition of the prosthesis, the length of hospitalization, complications in the hospital and after discharge. The Harris score of hip joint function was used to evaluate postoperative hip joint function. The average age of the 20 patients was 73.1 years. All patients were followed up by outpatient clinic or telephone. The follow-up time was 3-12 months, with an average of 9.2 months. There was no incision infection, no tissue structure damage such as important nerves and blood vessels, and no complications such as early dislocation, loosening of the joint prosthesis, and deep vein thrombosis of lower extremities. The efficacy of the last follow-up was evaluated according to the Harris score of hip joint function: an average of 91 points (78-98 points); 13 cases were excellent, 5 cases were good, and 2 cases were fair. The SuperPATH approach has the advantages of less surgical damage, shorter recovery time, good surgical safety, preserving the normal tension of the muscles around the hip joint, and reducing the incidence rate of early postoperative dislocation of the joint prosthesis. The THA of the SuperPATH approach can treat patients with displaced femoral neck fractures combined with schizophrenia safely and effectively.

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

BACKGROUND

SuperPATH is a novel minimally invasive technique for hip replacement that is gaining increasing attention. The aim of this review was to determine the nature, extent, and quality of current research evidence on SuperPATH and to identify areas for further investigations.

METHODS

A bibliometric search was conducted in PubMed up to 1 August 2023 using the search term "SuperPATH". Data extraction and quality assessment were performed for relevant articles.

RESULTS

The bibliometric search yielded 51 articles on SuperPATH, 9 of which were meta-analyses, 11 were randomized controlled trials (RCTs), 4 were prospective non-RCTs, 12 were retrospective comparative studies, 11 were case series, and 4 were other article types. Most articles were published between 2015 and 2023, with a steady increase in publications per year. The articles originated from 13 countries, of which China was the most productive (35%). The quality assessment of the meta-analyses showed that 22.2% were of moderate quality, 66.7% were of low quality, and 11.1% were of critically low quality. The quality assessment of the RCTs showed that 36.4% had a low risk of bias (RoB), 27.2% revealed some concerns, and 36.4% had a high RoB. All studies were evaluated for content and taken into account in the formulation of recommendations and conclusions.

CONCLUSIONS

The SuperPATH evidence varies from low to high quality. There is a steady increase in SuperPATH publications in the English-language literature and an uneven distribution of the article origins, with most articles coming from China. Consistent terminology should be used in the future, referring to the surgical approach as the direct superior approach (DSA) and to the surgical technique as SuperPATH. This review provides further concrete suggestions for future investigations and recommendations to improve study quality.

Minimally invasive surgery supercapsular percutaneously-assisted total hip (SuperPath) arthroplasty

BACKGROUND AND AIM

The benefits of minimally invasive surgical techniques in total hip arthroplasty (THA) are well known, but concerns about applying SuperPATH in patients with secondary OA of acetabular dysplasia do not have been reported. We aim to evaluate whether SuperPATH is applicable to secondary OA, furthermore, to quantify the recovery of lower extremity function.

METHODS

30 patients with secondary OA admitted for THA applying SuperPATH were investigated. Clinical Japanese Orthopaedic Association (JOA) Score and radiographical evaluation were performed. Following was examined pre- and early post-operatively; pain level, blood tests, TUG and 10-M walking time for lower limb recovery.

RESULTS

Preoperative radiographic measurements revealed an average Sharp angle of 46.2 ± 2.8 degrees and CE angle of 19.4 ± 7.3 degrees. 29 THAs had Crowe Type I and 1 THA had Crowe Type II. JOA score improved from 48.8 preoperatively to 91.5 at 2 months postoperatively. The perioperative pain assessment (VAS) averaged 7.0±1.5 preoperatively, 4.6±2.6 on the first postoperative day, then decreased gradually to 1.2±1.4 at 2 weeks. Blood data showed that creatine kinase, myoglobin, and CRP were significantly elevated on the day after surgery, but they normalized at 2 weeks postoperatively. Both TUG and 10M walking time showed slightly higher values at 1 week postoperatively compared to preoperatively but recovered to the same level as preoperatively at 2 weeks after surgery.

CONCLUSIONS

Our data suggests that SuperPATH approach to THA for dysplastic OA was applicable to mildly dysplastic OA and achieved an early recovery of lower limb function.

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

The SuperPATH approach is a direct superior portal-assisted approach for total hip arthroplasty (THA) that utilizes the interval between the gluteus minimus and the piriformis to access the hip capsule. Patients and Methods: SuperPATH arthroplasty was performed by a single surgeon between December of 2016 and December of 2021 in 344 cases. The technique described by Chow was performed in all cases. The average length of stay was 1.3 days, and all patients were discharged for home. All patients were mobilized on the day of the operation. Six cases presented complications: four intraoperative femur fractures and two peroneal nerve palsies. No infection and no hip dislocation were noticed in any case. Modifications: We recommend that the patient be placed as far from the surgeon as possible as well as the use of a sterilized standard linen pack to elevate the foot and internally rotate the hip. In addition, regarding instrumentation, we recommend the use of a 4.5 mm drill for the first guidance femur drilling and a standard corkscrew for femoral head removal. Finally, we propose a different reduction technique using a hook. The use of the SuperPATH approach allows for maximal tissue sparing through preservation of external rotators and minimizing stretching of the gluteus medius. There is no range of motion restrictions postoperatively and patients can achieve a high level of function with a very low dislocation risk and reduced inpatient stay. Furthermore, an incision extension is possible if needed in complex cases. For surgeons familiar with the standard posterolateral approach, the SuperPATH approach is a reliable and safe method with promising results for the patient. In order to improve the surgical effect and facilitate some steps in the procedure, we share our experience and recommend some modifications.

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

Introduction

Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach is a novel minimally invasive surgical technique for total hip arthroplasty (THA). This meta-analysis was conducted to evaluate the outcomes following THA via the SuperPATH approach in elderly patients with femoral neck fractures (FNFs), compared with those via traditional surgical approaches.

Methods

Eligible studies were retrieved through searching 7 electronic databases and manually screening related references. Objectives were surgical-related parameters, functional outcomes, and incidence of postoperative complications.

Results

9 comparative studies were included. Pooled results suggested that at the cost of longer operative time (WMD: 14.25, 95% CI: 3.25 to 25.25), the SuperPATH technique was superior to traditional approaches regarding incision length (WMD: −4.51, 95% CI: −6.46 to −2.56), intraoperative blood loss (WMD: −80.47, 95% CI: −122.36 to −38.57), and hospital stays (WMD: −3.35, 95% CI: −5.05 to −1.65). SuperPATH groups exhibited significantly increased Harris Hip Scores within 1 month after surgery (7d, WMD: 9.85, 95% CI: 6.40 to 13.30; 14d, WMD: 10.68, 95% CI: 8.29 to 13.08; 1 month, WMD: 6.17, 95% CI: 3.56 to 8.78) and had a reduced incidence of overall complications (OR: .19, 95% CI: .09 to .41). No significant differences were found between the 2 groups regarding postoperative pain relief.

Conclusion

Elderly patients with FNFs are potential candidates for THA treatment via the SuperPATH technique, which is associated with improved surgical outcomes, better short-term functional recovery, and lower risk of total complications as compared to traditional approaches. Additional studies are needed to further confirm our conclusions and validate the long-term efficacy of SuperPATH.

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

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.