Supercapsular percutaneously-assisted total hip (SuperPath) versus posterolateral total hip arthroplasty in bilateral osteonecrosis of the femoral head: a pilot clinical trial

Weikun Meng,Zhong Huang,Zongke Zhou,Zeyu Luo,Duan Wang,Yang Bai,Liang Gao,Guanglin Wang,Haoyang Wang

doi:10.1186/s12891-019-3023-0

Abstract

BackgroundThe supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA). Here, we compared the short-term outcomes of staged THA with the SuperPath or through posterolateral approach (PLA) for bilateral osteonecrosis of the femoral head (ONFH).MethodsPatients with bilateral late-stage ONFH were prospectively recruited from our department from March 2017 to March 2018. Staged bilateral THAs with one side SuperPath and the other side PLA were performed consecutively in the same patients with right and left hips alternating within approaches. The average time interval between the staged THAs was 3 months. Perioperative status (operation time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay) and postoperative function (range of motion, pain, and hip function) were recorded and compared between the SuperPath and PLA approaches within 12-month postoperatively.ResultsFour male patients (age, 51.00 ± 4.54; BMI, 21.49 ± 1.73) with bilateral alcohol-induced ONFH (Ficat III/IV) were followed up over 12 months postoperatively. Compared with the PLA, the SuperPath yielded shorter incision length (7.62 vs. 11.12 cm), longer operation time (103.25 vs. 66.50 min), more blood loss (1108.50 vs. 843.50 ml), deficient abduction angle of the acetabular cup (38.75° vs. 44.50°), and inferior early-term hip function (Harris hip score, 72.50 vs. 83.25) at 12-month postoperatively. Soft tissue damage, length of hospital stay, postoperative pain, postoperative range of motion, and 12-month patient satisfaction were comparable between both approaches.ConclusionThe SuperPath may be a minimally invasive technique but the present study shows less favorable short-term outcomes than PLA for total hip arthroplasty in osteonecrosis of the femoral head. More investigations are required to provide convincing favorable evidences of the SuperPath over other traditional THA approaches.Trial registration informationThe trial was retrospectively registered in https://www.researchregistry.com (No. Researchregistry4993) on July 04, 2019. The first participant was enrolled on March 13, 2017.

Highlights

The supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA)
The SuperPath approach was associated with a longer operation time (103.25 ± 12.41 min) than the posterolateral approach (PLA) approach (66.50 ± 13.79 min) (Table 2)
The mean blood loss was higher in the SuperPath approach (1108.50 ml) than in the PLA approach (843.50 ml)

Summary

Introduction

The supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA). We compared the short-term outcomes of staged THA with the SuperPath or through posterolateral approach (PLA) for bilateral osteonecrosis of the femoral head (ONFH). To minimize the overall surgical aggression, the supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed as an emerging minimally invasive and tissue sparing surgical technique [12]. This portal-assisted approach accesses the hip capsule superiorly through the interval between the gluteus medius and piriformis without dissecting any muscles or tendons [13, 14]. Despite the increasing clinical attention and utilization of the Superpath, outcome comparisons between the SuperPath and other traditional approaches (e.g. PLA) for THA was seldomly undertaken to specify convincing evidence of clinical benefits of this novel technique

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