Conventional instrument SuperPATH approach versus the anterolateral approach for femoral head replacement: a randomized controlled comparison of efficacy

doi:10.12307/2021.270

Abstract

Abstract: BACKGROUND: The incision of anterolateral approach for femoral head replacement is larger; the cut muscle needs time to heal; and the recovery time is longer. The incision of the SuperPATH approach is very small, and it does not cut off the muscle, so it can recover quickly. However, it needs special artificial prosthesis and special instruments, and the cost is high.
OBJECTIVE: To compare the efficacy of conventional instrument SuperPATH approach and anterolateral approach for femoral head replacement.
METHODS: From December 2016 to August 2018, 43 elderly patients with femoral neck fracture were randomly divided into experimental group (21 cases, SuperPATH group) and control group (22 cases, anterolateral group). All patients were operated with conventional instruments and femoral head, The incision length, intraoperative blood loss, the time from skin incision to incision closure, the changes of hemoglobin and red blood cells before and after operation, the time of getting off the ground after operation, pain score and hip joint function score were recorded.
RESULTS AND CONCLUSION: All patients were followed up for 24 to 36 months. Among them, the length of incision, the time from skin incision to incision closure, the time to get off the ground after operation, Visual Analogue Scale score at 1 week, Harris score at 1 week and 3 months after operation were significantly different between the two groups (P < 0.05), and the experimental group was better than the control group. There was no significant difference in blood loss during operation, changes of erythrocytes and hemoglobin before and after operation, Visual Analogue Scale score at 3 months after operation and Harris score at 6 months after operation between the two groups (P > 0.05). These findings confirm that compared with anterolateral approach, SuperPATH approach has the advantages of shorter incision, less trauma and faster recovery.

Key words: femoral neck fracture, conventional instruments, bipolar femoral head replacement, SuperPATH, anterolateral approach, approach

CLC Number:

Ji Dong, Xia Liangzheng, Jiang Yunyun, Wang Kang, Deng Yinghu, Zhu Dongqi, Yuan Zhongshan, Li Shenghua. Conventional instrument SuperPATH approach versus the anterolateral approach for femoral head replacement: a randomized controlled comparison of efficacy[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(30): 4833-4838.

Figures/Tables 9

References

[1] 郭徽灵,汤发强,颜来鹏,等.改良前外侧入路与后外侧入路人工股骨头置换术治疗老年股骨颈骨折的比较[J].中国骨与关节损伤杂志,2020,35(10):1050-1052.
[2] CHOW J, PENENBERG B, MURPHY S. Modified micro-superior percutaneously-assisted total hip: early experiences & case reports. Curr Rev Musculoskelet Med. 2011;4(3):146-150.
[3] DELLA TORRE PK, FITCH DA, CHOW JC. Supercapsular percutaneously-assisted total hip arthroplasty: radiographic outcomes and surgical technique. Ann Transl Med. 2015;3(13):180.
[4] XIE J, ZHANG H, WANG L, et al. Comparison of supercapsular percutaneously assisted approach total hip versus conventional posterior approach for total hip arthroplasty: a prospective, randomized controlled trial. J Orthop Surg Res. 2017;12(1):138.
[5] 夏良政,袁中山,朱东起.SuperPATH入路双极股骨头置换治疗老年股骨颈骨折[J].临床骨科杂志,2020,23(3):399-401.
[6] 汪康,李胜华,邓英虎,等.改良SuperPATH入路双极人工股骨头置换术治疗老年股骨颈骨折早期疗效分析[J].中国骨与关节损伤杂志,2018,33(12):1276-1278.
[7] 夏良政,李胜华,袁中山,等.普通双极股骨头 SuperPATH 入路治疗老年股骨颈骨折[J].中国组织工程研究,2018,22(19):2953-2960.
[8] 陈华,夏良政,李胜华.前外侧入路人工双极股骨头置换治疗高龄患者股骨颈骨折疗效观察[J].中外医学研究,2013,11(16):121-122.
[9] 张博,林源,王志为,等.前外侧入路半髋置换治疗股骨颈骨折伴脑梗死后遗症患者术后临床效果观察[J].首都医科大学学报,2016, 37(5):684-687.
[10] 郭斌,杨建成,屠春晖,等.改良Hardinge 入路在全髋关节置换术中的应用效果[J].临床骨科杂志,2018,21(1):40-42.
[11] CARDENAS-NYLANDER C, BELLOTTI V, ASTARITA E, et al. Innovative approach in total hip arthroplasty: supercapsular percutaneously-assisted. Hip Int. 2016;26 Suppl 1:34-37.

[12] MITCHELL RJ, KAY AB, SMITH KM, et al. Early results of displaced femoral neck fragility fractures treated with supercapsular percutaneous-assisted total hip arthroplasty. Arthroplast Today. 2019; 5(2):193-196.
[13] 张涵,员晋,兰海.SuperPATH微创髋关节置换术治疗老年股骨颈骨折[J].中华创伤骨科杂志,2018,20(5):400-405.
[14] LEROY TE, HAYDEN BL, DESMARAIS J, et al. Early Outcome Comparison of the Posterior Approach and the Superior Approach for Primary Total Hip Arthroplasty. Arthroplast Today. 2020;6(3):508-512.
[15] WANG XD, LAN H, HU ZX, et al. SuperPATH Minimally Invasive Approach to Total Hip Arthroplasty of Femoral Neck Fractures in the Elderly: Preliminary Clinical Results. Orthop Surg. 2020;12(1):74-85.
[16] GOFTON W, FITCH DA. In-hospital cost comparison between the standard lateral and supercapsular percutaneously-assisted total hip surgical techniques for total hip replacement. Int Orthop. 2016;40(3):481-485.
[17] CHOW J, FITCH DA. In-hospital costs for total hip replacement performed using the supercapsular percutaneously-assisted total hip replacement surgical technique. Int Orthop. 2017;41(6):1119-1123.
[18] 梁晓雨,李晓光,薛探,等.SuperPATH微创全髋关节置换术于临床应用中的研究[J].中华肿瘤防治杂志,2016,23(S2):277-278.
[19] 贾建波,禹宝庆,吴良浩,等.传统后路与微创SuperPath入路的半髋置换治疗老年股骨颈骨折疗效比较[J].中华老年骨科与康复电子杂志,2017,3(4):223-230.
[20] 贾建波,禹宝庆,吴良浩.微创SuperPath入路人工股骨头置换术治疗老年股骨颈骨折的近期疗效[J].中华创伤骨科杂志,2016,18(11): 938-944.
[21] 黄钢勇,夏军,魏亦兵,等.SuperPATH 入路髋关节置换术治疗高龄老年股骨颈骨折短期临床疗效[J].国际骨科学杂志,2016,37(5):331-336.
[22] BODROGI AW, SCIORTINO R, FITCH DA, et al. Use of the supercapsular percutaneously assisted total hip approach for femoral neck fractures: surgical technique and case series. J Orthop Surg Res. 2016;11(1):113.
[23] 吴良浩,禹宝庆,陈帆成.SuperPATH微创入路人工股骨头置换治疗老年股骨颈骨折：前瞻性、开放性、随机对照临床试验[J].中国组织工程研究,2017,21(7):1009-1014.
[24] JIANBO J, YING J, XINXIN L, et al. Hip hemiarthroplasty for senile femoral neck fractures: Minimally invasive SuperPath approach versus traditional posterior approach. Injury. 2019;50(8):1452-1459.
[25] MURPHY SB. Technique of tissue-preserving, minimally-invasive total hip arthroplasty using a superior capsulotomy. Oper Tech Orthop.2004; 14(2):94-101.
[26] PENENBERG BL, BOLLING WS, RILEY M. Percutaneously assisted total hip arthroplasty (PATH): a preliminary report. J Bone Joint Surg Am. 2008;90 Suppl 4:209-220.
[27] 韩晓飞,孙振中,顾三军,等.SuperPath 与Moore 入路全髋关节置换术治疗老年股骨颈骨折早期疗效比较[J].创伤骨科杂志,2018,20(10): 730-734.
[28] TOTTAS S, TSIGALOU C, VERVERIDIS A, et al. Supercapsular Percutaneously Assisted total hip arthroplasty versus lateral approach in Total Hip Replacement. A prospective comparative study. J Orthop. 2020;21:406-415.
[29] CHOW J. SuperPath: The Direct Superior Portal-Assisted Total Hip Approach. JBJS Essent Surg Tech. 2017;7(3):e23.
[30] MENG W, HUANG Z, WANG H, et al. Supercapsular percutaneously-assisted total hip (SuperPath) versus posterolateral total hip arthroplasty in bilateral osteonecrosis of the femoral head: a pilot clinical trial. BMC Musculoskelet Disord. 2019;21(1):2.
[31] JIANG H, WANG LH, JIN YX, et al. Supercapsular percutaneously assisted total hip arthroplasty versus conventional posterior approach: Comparison of early functional results. Acta Orthop Traumatol Turc. 2020;54(5):511-515.
[32] RASULI KJ, GOFTON W. Percutaneously assisted total hip (PATH) and Supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty: learning curves and early outcomes. Ann Transl Med. 2015;3(13):179.
[33] LEI P, LIAO Z, PENG J, et al. Assessment of the Learning Curve of Supercapsular Percutaneously Assisted Total Hip Arthroplasty in an Asian Population. Biomed Res Int. 2020;2020:5180458.