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

Pengfei Lei,Jiang Peng,Zhan Liao,Qian Zhou,Guang Li,Xiao Xiao,Chunhua Yang

doi:10.1155/2020/5180458

Abstract

The supercapsular percutaneously assisted total hip (SuperPATH) approach is a microinvasive approach that was developed to minimize surgical disruption of soft tissue during routine total hip arthroplasty (THA). This study was aimed at assessing early outcomes and learning curves of the SuperPATH approach in one Chinese hospital's experience. Early outcomes of the first consecutive 78 SuperPATH cases (80 hips) performed by the 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 complication occurrence in each group were evaluated. Learning curves were assessed using operative time and intraoperative blood loss as surrogates. The operation time and intraoperative blood loss of groups A and B were more than those of groups 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 preoperatively 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 the 4 groups. In summary, for surgeons who are familiar with the standard posterolateral approach, they could achieve more familiarity with SuperPATH after 40 cases of surgery.

Highlights

Total hip arthroplasty (THA) is an effective treatment for hip osteoarthritis and other disorders like femoral neck fracture, femoral head necrosis, and acetabular dysplasia [1]
There was no statistically significant difference in terms of incision length and hospital stay among the 4 groups. (Table 2) The intraoperative blood loss and operation time of the patients in the 4 groups were basically flat in the trend line after 40 hips (Figures 1 and 2)
The SuperPATH approach is a new progress in minimally invasive THA; it combines the advantages of the SuperCap approach and PATH approach [6, 7, 14, 15]

Summary

Introduction

Total hip arthroplasty (THA) is an effective treatment for hip osteoarthritis and other disorders like femoral neck fracture, femoral head necrosis, and acetabular dysplasia [1]. There are 3 main classical approaches to the hip for THA: posterolateral (Kocher-Langenbeck), anterolateral (Watson-Jones), and anterior (Smith-Peterson). Large clinical studies have shown excellent results from all 3 methods of THA [2]. Cited modifications currently include the direct anterior approach (DAA), Anterior supine intermuscular approach (ASI or OCM), and modified miniposterior approach. Each of these minimally invasive approaches has been shown to be safe and effective, if performed outside of its “learning curve” [1]. Each learning curve has been reported to be different based on approach, author, and patient population [4]

Objectives

Methods

Results

Conclusion