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    Interventional procedure overview of supercapsular percutaneously assisted total hip arthroplasty for osteoarthritis

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    Additional information considered by IPAC

    Professional experts' opinions

    Expert advice was sought from consultants who have been nominated or ratified by their professional Society or Royal College. The advice received is their individual opinion and is not intended to represent the view of the society. The advice provided by professional experts, in the form of the completed questionnaires, is normally published in full on the NICE website during public consultation, except in circumstances but not limited to, where comments are considered voluminous, or publication would be unlawful or inappropriate.

    Two professional expert questionnaires for supercapsular percutaneously assisted total hip arthroplasty for osteoarthritis were submitted and can be found on the NICE website.

    Patient commentators' opinions

    NICE's Public Involvement Programme was unable to gather patient commentary for this procedure.

    Company engagement

    A structured information request was sent to one company who manufacture a potentially relevant device for use in this procedure. NICE received one completed submission. This was considered by the IP team and any relevant points have been taken into consideration when preparing this overview.

    Issues for consideration by IPAC

    • Ongoing trials:

    • Randomised Control Trial Comparing Short-term Outcomes After Direct Anterior and SuperPATH Approaches; NCT03746925; Canada; RCT; estimated enrolment n=100; estimated study completion date April 2021.

    • A prospective pilot, randomised controlled trial to compare two approaches for total hip arthroplasty: supercapsular percutaneously assisted approach (SuperPATH) versus conventional posterior approach; UK; RCT; estimated enrolment n=60.

    • In addition to the safety outcomes stated in the main summary above, some papers, that used the SuperPath approach in indications other than hip osteoarthritis or various indications (where the outcomes for hip osteoarthritis were not presented separately), reported extra complications:

    • Gofton et al. (2015) determined the 30-day all-cause readmission rate and discharge status for patients implanted using the SuperPath technique. This was a multicentre, retrospective study of 479 patients who had THA using the SuperPath approach (indications not reported). Complications included dislocation (0.8%), periprosthetic fracture (0.8%), and deep vein thrombosis (0.2%). There were no infections and pulmonary embolisms reported.

    • Mitchell et al. (2019) retrospectively reviewed of 37 patients with displaced femoral neck fragility fracture treated with THA using the SuperPath approach. During postoperative follow up, there were no incidents of symptomatic heterotopic ossification and no superficial or deep wound infections. There were 4 cases of intraoperative nondisplaced calcar fracture. Postoperative medical complications included 1 case of respiratory failure and subsequent discharge to hospice, 5 cases of urinary retention, 1 case of atrial fibrillation and 1 case of delirium.

    • Xu et al. (2019) determined the proportion of hidden blood loss, and to compare hidden blood loss of patients who had the SuperPath approach and the conventional posterior approach (the Moore approach). This was a non-randomised comparative study of 130 patients with displaced femoral neck fractures (Garden type III or IV) who had hip hemiarthroplasty. Postoperative complications in the SuperPath group included deep venous thrombosis (1.92%, 1/52), pneumonia (1.92, 1/52) and urine storage (1.92, 1/52).

    • Yan et al. (2017) compared the early effectiveness between SuperPath approach and traditional Hardinge approach in THA. This was a non-randomised comparative study of 154 patients (173 hips) with non-inflammatory joint disease having initial THA. In the SuperPath group, great trochantern fracture (n=1) and dislocation of the hip joint (n=2) were found. No injury of nerve or blood vessel, deep vein thrombosis, infection and prosthesis loosening were reported in the 2 group.

    • Kay et al. (2021) evaluated early results of patients having primary, elective THA using the SuperPath approach. In this case series, there were 214 patients with primary osteoarthritis, avascular necrosis, dysplasia, posttraumatic arthritis, rheumatoid arthritis and femoral neck non-union. Complications included intraoperative calcar fracture (n=3), periprosthetic femur fracture (n=1), early femoral revision (n=1), superficial infections (n=3), and wound necrosis (n=1).

    • Tottas et al. (2020) compared the minimal invasive (MIS) SuperPath approach with the standard modified Hardinge approach at the base of muscle damage due to serum markers, functional results and other perioperative and postoperative data. This was a non-randomised comparative study of 48 patients with osteoarthritis, dysplasia, protruzio and osteonecrosis. Deep venous thrombosis was reported in 1 patient in each group.