Comparison of early effectiveness between SuperPATH approach and Hardinge approach in total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAN Tingti ¹ , TIAN Shaoqi ² , WANG Yuanhe ² , YANG Xu ² , LI Tong ³ , LIU Jiangjun ¹ , PAN Pichun ¹ , WANG Rong ¹ , WANG Dandan ¹ ,  SUN Kang ²

1. Medical College of Qingdao University, Qingdao Shandong, 266073, P.R.China;
2. Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China;
3. The Second Department of General Surgery, the No.4 People’s Hospital of Jinan, Jinan Shandong, 250031, P.R.China;

Corresponding author：

SUN Kang, Email: sunkang_qy@aliyun.com

Keywords：

SuperPATH approach; Hardinge approach; mini-invasion; total hip arthroplasty; fast recovery

DOI：

10.7507/1002-1892.201609110

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Objective To compare the early effectiveness between SuperPATH approach and traditional Hardinge approach in total hip arthroplasty (THA). Methods 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. Results 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. Conclusion 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.

Citation： YANTingti, TIANShaoqi, WANGYuanhe, YANGXu, LITong, LIUJiangjun, PANPichun, WANGRong, WANGDandan, SUNKang. Comparison of early effectiveness between SuperPATH approach and Hardinge approach in total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(1): 17-24. doi: 10.7507/1002-1892.201609110 Copy

1.	张国栋, 杨晨, 杨光, 等. 全髋关节置换术中不同颈干角股骨假体对股骨近端解剖重建的比较研究. 中国修复重建外科杂志, 2016, 30(1): 30-34.
2.	白波, 陈玉书. 中国微创全髋人工关节置换术的现状和将来. 中华关节外科杂志(电子版), 2015, 9(6): 707-710.
3.	Berger RA, Jacobs JJ, Meneghini RM, et al. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res, 2004, (429): 239-247.
4.	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.
5.	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.
6.	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.
7.	Gofton W, Chow J, Olsen KD, et al. Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique. Int Orthop, 2015, 39(5): 847-851.
8.	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.
9.	Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg (Br), 1982, 64(1): 17-19.
10.	Pradhan R. Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs. J Bone Joint Surg (Br), 1999, 81(3): 431-435.
11.	Tiberi JV 3rd, Antoci V, Malchau H, et al. What is the Fact of Total Hip Arthroplasty (THA) Acetabular Component Orientation When Evaluated in the Standing Position? J Arthroplasty, 2015, 30(9): 1555-1560.
12.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hipreplacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
13.	Leunig M, Faas M, von Knoch F, et al. Skin crease ‘bikini’ incision for anterior approach total hip arthroplasty: surgical technique and preliminary results. Clin Orthop Relat Res, 2013, 471(7): 2245-2252.
14.	Murphy SB . Technique of tissue-preserving, minimally-invasive total hip arthroplasty using a superior capsulotomy. Operative Techniques in Orthopaedics, 2004, 14(2): 94-101.
15.	张先龙, 吴海山. 人工关节置换临床实践与思考. 北京: 人民卫生出版社, 2012: 273-275.
16.	秦啸龙, 张先龙, 蒋垚, 等. 股外侧皮神经的手术安全区与前侧入路微创全髋关节置换术切口的选择. 中华关节外科杂志(电子版), 2008, 2(3): 21-23.
17.	Steiger RN, Lorimer M, Solomon M. What is the learning curve for the anterior approach for total hip arthroplasty? Clin Orthop Relat Res, 2015, 473(12): 3860-3866.
18.	Christensen CP, Karthikeyan T, Jacobs CA. Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. J Arthroplasty, 2014, 29(9): 1839-1841.
19.	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.
20.	Abe K, Yuda S, Yasui K, et al. Soleal vein dilatation assessed by ultrasonography is an independent predictor for deep vein thrombosis after major orthopedic surgery. J Cardiol, 2016. [Epub ahead of print].
21.	Goftonl 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.
22.	王坤正. 浅谈中国关节置换外科的现状与未来. 中华关节外科杂志(电子版), 2015, 9(6): 703-706.
23.	Goyal P, Lau A, McCalden R, et al. Accuracy of the modified Hardinge approach in acetabular positioning. Can J Surg, 2016, 59(4): 247-253.

1. 张国栋, 杨晨, 杨光, 等. 全髋关节置换术中不同颈干角股骨假体对股骨近端解剖重建的比较研究. 中国修复重建外科杂志, 2016, 30(1): 30-34.
2. 白波, 陈玉书. 中国微创全髋人工关节置换术的现状和将来. 中华关节外科杂志(电子版), 2015, 9(6): 707-710.
3. Berger RA, Jacobs JJ, Meneghini RM, et al. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res, 2004, (429): 239-247.
4. 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.
5. 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.
6. 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.
7. Gofton W, Chow J, Olsen KD, et al. Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique. Int Orthop, 2015, 39(5): 847-851.
8. 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.
9. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg (Br), 1982, 64(1): 17-19.
10. Pradhan R. Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs. J Bone Joint Surg (Br), 1999, 81(3): 431-435.
11. Tiberi JV 3rd, Antoci V, Malchau H, et al. What is the Fact of Total Hip Arthroplasty (THA) Acetabular Component Orientation When Evaluated in the Standing Position? J Arthroplasty, 2015, 30(9): 1555-1560.
12. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hipreplacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
13. Leunig M, Faas M, von Knoch F, et al. Skin crease ‘bikini’ incision for anterior approach total hip arthroplasty: surgical technique and preliminary results. Clin Orthop Relat Res, 2013, 471(7): 2245-2252.
14. Murphy SB . Technique of tissue-preserving, minimally-invasive total hip arthroplasty using a superior capsulotomy. Operative Techniques in Orthopaedics, 2004, 14(2): 94-101.
15. 张先龙, 吴海山. 人工关节置换临床实践与思考. 北京: 人民卫生出版社, 2012: 273-275.
16. 秦啸龙, 张先龙, 蒋垚, 等. 股外侧皮神经的手术安全区与前侧入路微创全髋关节置换术切口的选择. 中华关节外科杂志(电子版), 2008, 2(3): 21-23.
17. Steiger RN, Lorimer M, Solomon M. What is the learning curve for the anterior approach for total hip arthroplasty? Clin Orthop Relat Res, 2015, 473(12): 3860-3866.
18. Christensen CP, Karthikeyan T, Jacobs CA. Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. J Arthroplasty, 2014, 29(9): 1839-1841.
19. 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.
20. Abe K, Yuda S, Yasui K, et al. Soleal vein dilatation assessed by ultrasonography is an independent predictor for deep vein thrombosis after major orthopedic surgery. J Cardiol, 2016. [Epub ahead of print].
21. Goftonl 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.
22. 王坤正. 浅谈中国关节置换外科的现状与未来. 中华关节外科杂志(电子版), 2015, 9(6): 703-706.
23. Goyal P, Lau A, McCalden R, et al. Accuracy of the modified Hardinge approach in acetabular positioning. Can J Surg, 2016, 59(4): 247-253.

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