SuperPATH Approach Research Articles

Early results of displaced femoral neck fragility fractures treated with supercapsular percutaneous-assisted total hip arthroplasty

BackgroundTotal hip arthroplasty (THA) is the preferred treatment for displaced femoral neck fractures in select patients, although dislocation remains a concern. In some studies, the supercapsular percutaneously assisted (SuperPATH) approach has demonstrated early mobilization, short hospital stay, and low dislocation rates in primary THA, but there are little data on its use for fractures. This study describes the perioperative outcomes and early dislocation rate of SuperPATH THA for displaced femoral neck fragility fractures.MethodsA retrospective review was performed of previous ambulatory patients with a displaced femoral neck fragility fracture treated with THA using the SuperPATH approach. Demographic data, time to ambulation, length of stay, and in-hospital complications during the hospital stay and follow-up period were recorded. Phone interviews were conducted to check for dislocations 1 year after surgery.ResultsThirty-seven consecutive patients were included with an average age of 75.0 years. Hospital stay averaged 5.5 days, and patients were discharged on average postoperative day 3.6. About 83.8% of patients were ambulatory by postoperative day 1, and 94.6% ambulatory before discharge. Twenty-seven percent of patients were discharged home, 46% to inpatient rehabilitation, 24% to skilled nursing facility, and 1 patient to hospice. At follow-up, there was no symptomatic heterotopic ossification and no infections. Thirty-two patients were available for telephone interviews at 1 year, with no dislocations reported.ConclusionsIn this small cohort, the SuperPATH approach for THA appears to be safe and effective for use in femoral neck fragility fractures, resulting in early ambulation and a low dislocation rate.

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

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.

Comparison of effectiveness between SuperPATH approach and posterolateral approach in total hip arthroplasty

To compare the effectiveness between SuperPATH approach and posterolateral approach in total hip arthroplasty (THA). Between January 2016 and December 2016, 84 patients with hip disease were included in the study and randomly divided into 2 groups. Forty patients were treated with THA via SuperPATH approach (SuperPATH group), and 44 patients were treated with THA via posterolateral approach (PSA group). There was no significant difference in gender, age, body mass index, the type of disease, the complicating diseases, and preoperative thrombosis of lower extremity and Harris score between 2 groups ( P>0.05). The operation time, intraoperative blood loss, length of incision, postoperative drainage volume, unloaded activity time, Harris score, and short-form 36 health survey scale (SF-36) score were compared. The postoperative X-ray films were used to observe the position of joint prosthesis. All patients were followed up 6-18 months (mean, 10.3 months). The operation time, intraoperative blood loss, length of incision, postoperative drainage volume, and unloaded activity time in SuperPATH group were significantly superior to those in PSA group ( P<0.05). The Harris score at 2 weeks and 1 month after operation were significantly higher in SuperPATH group than that in PSA group ( P<0.05). But there was no significant difference in the Harris scores at 3 and 6 months after operation between 2 groups ( P>0.05). At last follow-up, the SF-36 scores were higher in SuperPATH group than those in PSA group ( P<0.05). Postoperative X-ray films showed the joint prosthesis was in good position. THA via SuperPATH approach has the advantages of minimal invasion, safe, and rapid recovery, which is better than THA via posterolateral approach.

Comparison of supercapsular percutaneously assisted approach total hip versus conventional posterior approach for total hip arthroplasty: a prospective, randomized controlled trial

BackgroundTotal hip arthroplasty (THA) has been one of the most successful orthopedic procedures over the past 30 years. Nowadays, the techniques of exposure for THA have undergone great changes, allowing surgeons to perform THA through mini-incisions. Recently, a novel minimally invasive surgical technique of the supercapsular percutaneously assisted total hip arthroplasty was reported in 2011. The purpose of this study was to compare the SuperPath approach with the conventional posterior approach, in terms early outcomes and radiologic results.MethodsNinety-two consecutive unilateral primary hip osteoarthritis adult patients were randomly divided into two groups. Forty-six patients (SuperPath group) were operated on using the SuperPath approach, and 46 patients (conventional group) were operated on with the conventional posterior approach. Outcomes were evaluated using preoperative index, intraoperative data, and postoperative function data. The positioning of the implants was analyzed by radiography.ResultsNo significant difference was detected in skin-to-skin operation time, blood loss, transfusion rate, postoperative complications, abduction angle, anteversion angle, and stem alignments. The incision length and length of stay (LOS) in the SuperPath group were significantly lower. The VAS score in the SuperPath group at the 1-week, 1-month and 3-month postoperative intervals were lower than those VAS scores in the conventional group. The Harris Hip Score and Barthel Index (BI) for Activities of Daily Living in the SuperPath group were significantly higher at the 1- and 3-month follow-up intervals and were not significantly different 1 year after operation.ConclusionsThis prospective randomized study reveals that the SuperPath technique was associated with shorter LOS, earlier time to walk and climb, and lower postoperative pain levels. It also allowed early postoperative rehabilitation and faster recovery than conventional technique.

Comparison of early effectiveness between SuperPATH approach and Hardinge approach in total hip arthroplasty

To compare the early effectiveness between SuperPATH approach and traditional Hardinge approach in total hip arthroplasty (THA). Between May 2015 and March 2016, 154 patients (173 hips) undergoing initial THA were included. THA was performed by SuperPATH approach in 64 cases (70 hips) in group A and by traditional Hardinge approach in 90 cases (103 hips) in group B. There was no significant difference in gender, age, body mass index, type of disease, and Harris hip score (HHS) between 2 groups ( P>0.05). The incision length, operation time, intraoperative blood loss, postoperative drainage volume, transfusion rate, ambulation time, length of stay, and complications were recorded. The HHS and visual analogue scale (VAS) were compared between 2 groups before operation and at 1 day, 3 days, 1 week, 3 weeks, 6 weeks, 12 weeks, and 24 weeks after operation. And the relative parameters were measured for imaging evaluation of prosthesis position. In addition, the stratification analysis was performed on 92 patients (100 hips) who received the SuperPATH technology. The incision length, ambulation time, and length of stay in group A were significantly less than those in group B ( P<0.05); the operation time, transfusion rate, and intraoperative blood loss of group A were significantly higher than those of group B ( P<0.05); and there was no significant difference in postoperative drainage volume between 2 groups ( t=1.901, P=0.071). The follow-up period was 6 to 15 months (mean, 9 months). The VAS scores at 1 day, 3 days, and 1 week after operation in group A were significantly lower than those in group B ( P<0.05), but the HHS scores at 1 day, 3 days, 1 week, and 3 weeks after operation in group A were significantly higher than those in group B ( P<0.05). At 24 weeks after operation, the acetabular cup abduction and the proportion within the safe zone showed no significant difference between 2 groups ( P>0.05); the anteversion angle and limb length difference in group A were significantly greater than those in group B ( P<0.05), and the proportion of anteversion angle within the safe zone and eccentricity and recovery rate were significantly lower than those in group B ( P<0.05). In the stratification analysis, the operation time, incision length, intraoperative blood loss, transfusion rate, and VAS score at 1 day after operation in the former 30 hips were significantly higher than those in the latter 70 hips ( P<0.05). Great trochantern fracture and dislocation of the hip joint occurred in 1 and 2 of the former 30 hips, but no complications occurred in the latter 70 hips. No injury of nerve or blood vessel, deep vein thrombosis, infection, and prosthetic loosening were observed in the 2 groups. Compared with the Hardinge approach, the SuperPATH approach shows the advantages in little trauma, fast recovery, satisfactory effectiveness, and slight early postoperative pain, but it shows the disadvantages of much intraoperative blood loss and long operation time. In addition, SuperPATH approach needs a more anteverted angle, a smaller eccentricity, and a learning curve, so the mid-term and long-term outcomes still need further follow-up study.

Supercapsular percutaneously-assisted total hip approach for the elderly with femoral neck fractures: study protocol for a prospective, open-label, randomized, controlled clinical trial

Background: Artificial hip replacement by the posterolateral approach is generally introduced as a treatment for femoral neck fracture in the elderly, but it is limited by the need for a large incision, cutting off the extortor, and postoperative hip dislocation. The supercapsular percutaneously-assisted total hip (SuperPATH) approach was developed based on the original lateral approach. The SuperPATH approach for hip replacement is characterized by the reduced chance of damaging blood vessels and nerves, reducing intraoperative blood loss, retaining all the joint capsules and supinator, and significantly reducing the incidence of postoperative hip dislocation. Given these advantages, we hypothesized that the SuperPATH approach for hip replacement can achieve better efficacy in the elderly with femoral neck fractures and promote the recovery of postoperative hip function compared with the posterolateral approach. Methods/Design: This is a prospective, single-center, open-label, randomized controlled clinical trial that will be completed at the Pudong Hospital of Fudan University, Shanghai, China. Forty patients with femoral neck fractures were randomly divided into two groups to undergo femoral head replacement by the SuperPATH approach in the experimental group, and by the conventional posterior approach in the control group. The follow-up period is 1 week and 6 months. The primary outcome measure is Harris hip scores at baseline, and at 1 week and 6 months postoperatively to assess functional recovery of the hip. Secondary outcome measures to evaluate the advantages of the SuperPATH approach include the length of surgical incision, intraoperative blood loss, operative time, 24-hour postoperative drainage, and hospital stay. Other outcome measures include the incidence of adverse events at 1 week and 6 months after surgery. Discussion: The aim of this trial is to test our hypothesis that the SuperPATH approach is safer and more reliable for hip functional recovery compared with the posterolateral approach for the artificial hip replacement in femoral neck fractures of the elderly. Trial registration: ClinicalTrials.gov identifier: NCT03134664. Ethics: The study protocol was approved by the Ethics Committee of the Pudong Hospital of Fudan University, China, and performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Written informed consent was obtained from all participants prior to the trial commencement.

Minimally invasive SuperPath approach in artificial femoral head replacement for senile femoral neck fractures

Objective To evaluate the short-term clinical outcomes of minimally invasive SuperPath approach in hip artificial femoral head replacement for senile femoral neck fractures. Methods From December 2015 to March 2016, 18 senile patients with femoral neck fracture underwent femoral head replacement via the SuperPath approach. They were 3 males and 15 females, with a mean age of 77.6 years (range, from 75 to 90 years). Their operation time, intraoperative blood loss, length of incision, 48-hour drainage after operation, time for weight-bearing activity and complications were recorded. Harris score was used to evaluate the hip joint function preoperatively, 2 days and 6 months after operation. Results Surgery succeeded in the 18 patients. The operation time averaged 53.3 minutes, the intraoperative blood loss 108.9 mL, the incision length 7.1 cm, the 48-hour drainage after operation 86.1 mL, and the time for weight-bearing activity 2.6 days. All the patients were discharged uneventfully 2 weeks after operation. No such complications as deep vein thrombosis, paralysis of the sciatic nerve, joint infection or dislocation occurred. The mean Harris score of the affected hips 2 days after operation (67.9±5.1 points) was significantly higher than the preoperative one (13.4±3.9 points) (P<0.05). The mean Harris score of the affected hips 6 months after operation (96.1±3.0 points) was significantly higher than that 2 days after operation (67.9±5.1 points) (P<0.05). Conclusion The SuperPath approach can effectively enhance functional recovery of the affected hip, reduce pain, and improve the patients’ quality of life in artificial femoral head replacement for elderly patients with femoral neck fracture. Key words: Femoral neck fractures; Arthroplasty, replacement, hip; Surgical procedures, minimally invasive; Surgical approach

Supercapsular percutaneously-assisted total hip arthroplasty: radiographic outcomes and surgical technique.

The supercapsular percutaneously-assisted total hip (SuperPATH(®)) approach for total hip arthroplasty (THA) was developed to promote early mobilization and greater range of motion, physiologic gait kinematics and improved pain control. The superpath approach is a hybrid of the Superior Capsulotomy (SuperCap(®)) approach and the percutaneously assisted total hip (PATH(®)) technique. Postoperative radiographs of 66 consecutive patients from the first 100 patients who underwent the SuperPATH approach were analysed by an independent third party for component position and seating, femoral offset and leg length. A detailed description of preoperative and postoperative preparation, soft tissue dissection, preparation of the femoral canal and acetabulum, and implant positioning is also provided with figures to illustrate. All components in this case series were well seated and position deemed optimal. Leg lengths were measured to within 5 mm of the contralateral side and mean acetabular abduction angle was 40.13° (SD 6.30°). Through preservation of the external rotators, hip capsule, and abductor integrity, the SuperPATH approach for THA maximally preserves the surrounding soft tissue envelope. Implant position was optimal within the 'learning curve' of the first 100 cases for described THA safe zones. Long term outcome data for the SuperPATH approach are being collected as part of an ongoing study to compare to favourable short and mid-term results.

Fragment assembly with double-barreled data.

For the last twenty years fragment assembly was dominated by the "overlap - layout - consensus" algorithms that are used in all currently available assembly tools. However, the limits of these algorithms are being tested in the era of genomic sequencing and it is not clear whether they are the best choice for large-scale assemblies. Although the "overlap - layout - consensus" approach proved to be useful in assembling clones, it faces difficulties in genomic assemblies: the existing algorithms make assembly errors even in bacterial genomes. We abandoned the "overlap - layout - consensus" approach in favour of a new Eulerian Superpath approach that outperforms the existing algorithms for genomic fragment assembly (Pevzner et al. 2001 InProceedings of the Fifth Annual International Conference on Computational Molecular Biology (RECOMB-01), 256-26). In this paper we describe our new EULER-DB algorithm that, similarly to the Celera assembler takes advantage of clone-end sequencing by using the double-barreled data. However, in contrast to the Celera assembler, EULER-DB does not mask repeats but uses them instead as a powerful tool for contig ordering. We also describe a new approach for the Copy Number Problem: "How many times a given repeat is present in the genome?". For long nearly-perfect repeats this question is notoriously difficult and some copies of such repeats may be "lost" in genomic assemblies. We describe our EULER-CN algorithm for the Copy Number Problem that proved to be successful in difficult sequencing projects.