Randomized controlled trial of comparison between the SuperPATH and posterolateral approaches in total hip arthroplasty

Abstract

To evaluate the effectiveness of SuperPATH approach in total hip arthroplasty (THA) compared with conventional posterolateral approach. Between March 2017 and May 2017, 24 patients who planned to have a unilateral THA were enrolled in the study and randomized into 2 groups. Twelve patients were treated with SuperPATH approach (SuperPATH group) and 12 patients with posterolateral approach (control group). There was no significant difference in gender, age, body mass index, the type of disease, complicating diseases, and American Society of Anesthesiologists grading between 2 groups ( P>0.05). The operation time, length of stay, length of incision, and perioperative complications related to operation were recorded. The hemoglobin and hematocrit were recorded; the total blood loss and intraoperative blood loss were calculated. The inflammatory response indicators (C-reactive protein, erythrocyte sedimentation rate) and muscle damage index (creatine kinase) were recorded in both groups. The range of motion, functional score (Harris score), visual analogue scale (VAS) score, and prosthesis position were recorded. Patients in both groups were followed up 1 year. Compared with the control group, the operation time of the SuperPATH group was longer ( t=4.470, P=0.000), and the incision was shorter ( t=-2.168, P=0.041). There was no significant difference in length of stay between 2 groups ( t=0.474, P=0.640). Periprosthetic fracture occurred in 1 case of the SuperPATH group. No other complications, such as infection or deep vein thrombosis, occurred in both groups. There was no significant difference in intraoperative blood loss, total blood loss, hemoglobin and hematocrit before operation and at 1 and 3 days after operation, and C-reactive protein and erythrocyte sedimentation rate before operation and at 1, 3, and 14 days between 2 groups ( P>0.05). For creatine kinase, SuperPATH group at 1 and 3 days were lower than control group ( P<0.05), while no significant difference was found between 2 groups before operation and at 14 days after operation ( P>0.05). For flexion and abduction activity, SuperPATH group at 1 and 3 days after operation were better than the control group ( P<0.05), while no significant difference was found between 2 groups at 14 days, 3 months, 6 months, and 1 year after operation ( P>0.05). The Harris and VAS scores of SuperPATH group at 1 and 3 days after operation were better than those of control group ( P<0.05). There was no significant difference in anteversion and abduction between 2 groups ( P>0.05) according to the X-ray film at 1 year. During the follow-up, no loosening or migration was observed. Compared with the posterolateral approach, the SuperPATH approach can reduce muscle damage, relieve early pain, promote recovery, and obtain the similar short-term effectiveness.