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

Branco CB, Sousa RM, Soursa D et al. (2021) Comparison of short-term outcomes between minimal invasive superpath approach and conventional posterior approach in total hip arthroplasty: a randomized controlled trial. International Journal of Research in Orthopaedics 7(3): 431-7

Randomised controlled trial

n=22 (SuperPath, n=11; posterior, n=11)

Despite the longer surgical time seen with the SuperPath approach, it managed to significantly decrease the length of hospital stay and obtained better results in improving pain in the short term (1 month).

Poor quality study at high risk of bias with 22 participants, participants not randomly allocated, follow-up only short-term.

Cardenas-Nylander C, Bellotti V, Astarita E et al. (2016) Innovative approach in total hip arthroplasty: supercapsular percutaneously-assisted. Hip international: the journal of clinical and experimental research on hip pathology and therapy 26suppl1: 34-7

Case series

n=21 (patients with non-inflammatory joint disease)

The SuperPath potentially minimises morbidity, reducing transfusion rates, allowing rapid recovery, shortening hospital stay and could save a significant cost to the healthcare system.

Small sample, limited efficacy and safety outcomes reported; and outcomes for hip osteoarthritis not reported separately.

Chow J and Fitch DA (2017) In-hospital costs for total hip replacement performed using the supercapsular percutaneously-assisted total hip replacement surgical technique. International orthopaedics 41(6): 1119-23

Non-randomised comparative study

n=2,092 (SuperPath, n=419; other THRs, n=1,673)

The use of this tissue-sparing surgical technique resulted in reductions in in-hospital costs, length of stay, and readmissions when compared to all other THRs done in a large hospital system in the United States.

This study compared the in-hospital costs of the SuperPath technique to all other THRs done in a large hospital system.

Della Torre PK, Fitch DA and Chow JC (2015) Supercapsular percutaneously-assisted total hip arthroplasty: radiographic outcomes and surgical technique. Ann Transl Med 3 (13):180

Case series

n=66

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°).

This study reported radiographic outcomes and described surgical technique. Limited efficacy data were reported.

Ge YZ, Chen ZX, Chen QS et al. (2021) A systematic-review and meta-analysis of the SuperPath approach in hip arthroplasty. BioMed Research International.

Systematic review and meta-analysis

n=6 studies

SuperPath, as a minimally invasive approach with its reduced tissue damage, quick postoperative recovery, and early rehabilitation, demonstrates the short-term advantages of hip arthroplasty. As the evidence in favour of the SuperPath technique were limited in a small number of studies and short duration of follow-up, more research is needed to further analyse its long-term effect.

Of the 6 included studies, 3 studies (Xie et al., 2017; Martinez et al. 2019; Meng et al., 2019) were for hip osteoarthritis. These 3 studies are included in the main summary.

Hu Y, Wang MC, Meng Y et al. (2021) Less blood loss in supercapsular percutaneously assisted versus posterolateral total hip arthroplasty. Journal of orthopaedic surgery and research 16(1): 217

Non-randomised comparative study

n=263 (SuperPath, n=85; posterolateral THA group, n=178)

SuperPath resulted in less perioperative blood loss and a lower transfusion rate than conventional THA.

This study determined the blood loss during SuperPath and compared the blood loss with conventional posterolateral THA. Preoperative diagnoses included femoral neck fracture, necrosis of femoral head and hip osteoarthritis. The outcomes for osteoarthritis were not reported separately.

Jiang H, Wang LH, Jin YX et al. (2020) Supercapsular percutaneously assisted total hip arthroplasty versus conventional posterior approach: Comparison of early functional results. Acta orthopaedica et traumatologica turcica 54(5): 511-5

Non-randomised comparative study

n=58 (SuperPath, n=28; conventional posterior approach, n=30)

Compared with the conventional posterior approach, the SuperPath approach provided better early functional results with less postoperative pain and shorter hospitalisation time. However, the operation time was longer in the SuperPath approach group.

Preoperative diagnoses included femoral neck fracture, aseptic necrosis of the femoral head or osteoarthritis. The outcomes for osteoarthritis of the hip were not reported separately.

Kay A, Klavas D, Haghshenas V et al. (2021) Two year follow up of supercapsular percutaneously assisted total hip arthroplasty. BMC musculoskeletal disorders 22(1): 478

Case series

n=214

SuperPath approach is safe for use in primary THA resulting in a low dislocation rate.

Preoperative diagnoses included primary osteoarthritis, avascular necrosis, dysplasia, post-traumatic arthritis, rheumatoid arthritis and femoral neck non-union. The outcomes for osteoarthritis of the hip were not reported separately.

Qurashi S, Chinnappa J, Lord SJ et al. (2017) Driving after microinvasive total hip arthroplasty. The Journal of arthroplasty 32(5): 1525-9

Case series

n=94

Brake reaction time reached preoperative values by day 2 following microinvasive THA. Patients may be suitable to drive earlier than the previously recommended 6 weeks postoperation.

Hip pathology included osteoarthritis, dysplasia and avascular necrosis. This study evaluated patients' ability to drive in the early postoperative period following THA using the SuperPath approach by assessing break reaction time.

Qurashi S, Chinnappa J, Rositano P et al

(2016) SuperPath® minimally invasive total hip arthroplasty - an Australian experience. JISRF Reconstr Rev 6(2).

Case series

n=100

SuperPath is a safe technique of hip arthroplasty with excellent functional recovery and patient satisfaction.

Preoperative hip pathology included osteoarthritis, avascular necrosis, postseptic arthritis, ankylosing spondylitis and developmental dysphasia of the hip. The outcomes for osteoarthritis were not reported separately.

Ramadanov N, Bueschges S, Liu K et al. (2020) Comparison of short-term outcomes between SuperPath approach and conventional approaches in hip replacement: a systematic review and meta-analysis of randomized controlled trials. Journal of orthopaedic surgery and research 15(1): 420

Systematic review and meta-analyses

n=726 (12 RCTs)

SuperPath approach showed better results in decreasing incision length and early pain intensity as well as improving short-term functional outcome. Long-term outcomes of SuperPath approach need to be investigated.

Preoperative diagnoses were osteoarthritis, femoral neck fracture, and avascular necrosis of the femoral head. The outcomes for osteoarthritis of the hip were not reported separately.

Ramadanov N, Bueschges S, Liu K et al. (2021) Comparison of short-term outcomes between direct anterior approach (DAA) and SuperPath in total hip replacement: a systematic review and network meta-analysis of randomized controlled trials. Journal of orthopaedic surgery and research 16(1): 324

Systematic review and meta-analysis

n=1,392 (16 RCTs)

The findings suggested that the short-term outcomes of THA through SuperPath were superior to DAA. SuperPath showed better results in decreasing operation time, incision length, intraoperative blood loss, and early pain intensity. DAA and SuperPath were equal in functional outcome and acetabular cup positioning.

Preoperative diagnoses were osteoarthritis, femoral neck fracture, and avascular necrosis of the femoral head. The outcomes for osteoarthritis of the hip were not reported separately.

Tottas S, Kougioumtzis IE, Tsigalou C et al. (2020) Supercapsular percutaneously assisted total hip arthroplasty versus lateral approach in total hip replacement. A prospective comparative study. Journal of Orthopaedics 21: 406-15

Non-randomised comparative study

n=48 (SuperPath, n=25; Hardinge, n=23)

This study revealed some advantages in favour of the SuperPath approach comparing with the standard modified Hardinge approach, mainly in terms of less muscle damage and less perceived pain postoperatively. More research is needed to further elucidate its efficacy.

Small sample.

Preoperative diagnoses included osteoarthritis, dysplasia, protruzio and osteonecrosis. The outcomes for osteoarthritis of the hip were not reported separately