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

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    Efficacy summary

    Improvement in symptoms and functioning

    HHS

    In a randomised controlled trial of 92 patients with unilateral primary hip osteoarthritis, the mean HHS scores were statistically significantly higher in the SuperPath group than the conventional posterior group at 1 week (73.8±3.89 compared with 69±4.81, p=0.009), 1 month (81.4±3.18 compared with 76.8±2.93, p=0.000) and 3 months (87.6±1.76 compared with 80.1±4.49, p=0.000) postoperation but not at 1 year (92.3±1.62 compared with 91.6±2.41, p=0.26; Xie 2017).

    In a randomised controlled trial of 40 patients with unilateral end-stage primary hip osteoarthritis, the mean HHS scores were higher in the SuperPath group than the posterolateral group at days 1, 3 and 14, and months 3, 6 and 12 after operation. However, the differences were not statistically significant:

    • postoperative day 1: 62.50±10.07 compared with 60.11±6.46, p=0.443

    • postoperative day 3: 66.44±9.03 compared with 63.50±7.17, p=0.293

    • postoperative day 14: 72.27±8.33 compared with 70.66±6.22, p=0.339

    • postoperative 3 months: 82.44±3.51 compared with 82.38±2.68, p=0.815

    • postoperative 6 months: 87.77±3.47 compared with 87.55±3.56, p=0.839

    • postoperative 12 months: 92.16±2.76 compared with 92.66±2.80, p=0.988.

    Improvement in hip function reached its maximum plateau between 3 and 12 months in both groups (Meng 2021).

    In a randomised controlled trial of 44 patients with unilateral non-inflammatory degenerative joint disease, the mean HHS was statistically significantly higher in the SuperPath group than the mini posterior group at 6 weeks after operation (78.6±9.18 compared with 68.8±15.1, p=0.01). At baseline, both groups were comparable in HHS (45.6±11.3 compared with 46±11, p=0.79; Korytkin 2021).

    In a non-randomised comparative study of 90 patients with hip arthrosis, the mean HHS scores were comparable between patients who had THA using the SuperPath approach and patients who had THA using the posterior approach at 3 months (91.6±8.8 compared with 93.7±5.4, p=0.51), 6 months (90.2±12.8 compared with 92.4±9.3, p=0.21) and 1 year (98.2±2.0 compared with 96.2±5.6, p=0.24) after surgery. When comparing with preoperative values, the mean HHS scores statistically significantly increased at 1 year in both groups (SuperPath, 48.8±7.1 at baseline compared with 98.2±2.0 at 1 year postoperation, p<0.001; posterior, 50.0±14.5 at baseline compared with 96.2±5.6 at 1 year postoperation, p<0.001; Mas Martinez 2019).

    HOOS

    In the randomised controlled trial of 44 patients, the mean HOOS score was statistically significantly higher in the SuperPath group than the mini posterior group at 6 weeks after operation (81.3±10.9 compared with 72.47±13.5, p=0.01). There was no statistically significant difference in preoperative HOOS score between the 2 groups (40.1±10.3 compared with 41.3±15.7, p=0.75; Korytkin 2021).

    ROM

    In the randomised controlled trial of 40 patients, the mean ROMs for flexion of the affected hip were statistically significantly lower in the SuperPath group than the posterolateral group at postoperative days 1, 3 and 14 (SuperPath, 107.66°, 109.83°, 111.66°; posterolateral, 114.44°, 116.11°, 118.88°; all p<0.05). The differences between the 2 groups at 3, 6 and 12 months were not statistically significant (SuperPath, 119.72°, 121.44°, 124.72°; posterolateral, 121.22°, 123.05°, 124.16°). There were no statistically significant differences in mean ROMs for abduction, adduction and external rotation between the 2 groups at all time points (all p>0.05; Meng 2021).

    WOMAC function

    In the non-randomised comparative study of 90 patients, the mean WOMAC function scores were not statistically significantly different between the SuperPath group and the posterior group at 3 months (85.4±12.6 compared with 79.7±14.6, p=0.24), 6 months (92.9±12.9 compared with 89.6±14.6, p=0.28) and 1 year (93.0±13.6 compared with 91.6±13.4, p=0.44) after operation. When comparing with preoperative values, the mean WOMAC function scores statistically significant increased at 1-year follow up in both groups (SuperPath, 31.8±13.8 at baseline compared with 93.0±13.6 at 1-year follow up, p<0.001; posterior, 39.5±14.7 at baseline compared with 91.6±13.4 at 1-year follow up, p<0.001; Mas Martinez 2019).

    Merle d'Aubigné Hip Score

    In the non-randomised comparative study of 90 patients, the mean Merle d'Aubigné hip scores were not statistically significantly different between the SuperPath group and the posterior group at 3 months (10.7±1.4 compared with 11.0±1.3, p=0.55), 6 months (10.1±2.1 compared with 10.6±1.4, p=0.41) and 1 year (11.8±0.4 compared with 11.3±0.8, p=0.14) after operation. When comparing with preoperative values, statistically significant improvements were reported at 1 year in both groups (SuperPath, 5.1±1.8 at baseline compared with 11.8±0.4 at 1 year postoperation, p<0.001; posterior, 5.7±1.9 at baseline compared with 11.3±0.8 at 1 year postoperation, p<0.001; Mas Martinez 2019).

    Improvement in activities of daily living

    HOS

    In the non-randomised comparative study of 90 patients, the mean HOS scores for activities of daily living were not statistically significantly different between the SuperPath and posterior groups at 3 months (84.2±14.7 compared with 75.1±18.8, p=0.15), 6 months (82.3±17.7 compared with 80.5±19.7, p=0.77) and 1 year (89.8±13.1 compared with 84.2±18.0, p=0.42) after surgery. When comparing with preoperative values, the mean HOS scores for activities of daily living statistically significantly increased at 1-year follow up in both groups (SuperPath, 38.6±13.5 compared with 89.8±13.1, p<0.001; posterior, 39.2±13.1 compared with 84.2±18.0, p<0.001; Mas Martinez 2019).

    Barthel index

    In the randomised controlled trial of 92 patients, the mean Barthel index scores for activities of daily living were statistically significantly higher in the SuperPath group than the conventional posterior group at 1-week (70.67±9.47 compared with 64.46±7.70, p=0.000), 1-month (79.6±10.01 compared with 74.26±5.76, p=0.017) and 3-month (90.26±7.12 compared with 83.07±8.62, p=0.01) follow ups but not at 1-year follow up (94.33±6.90 compared with 93.60±8.74, p=0.334; Xie 2017).

    Change in TUG, TSC and gait velocity

    In the randomised controlled trial of 92 patients, the mean TUG and TSC were statistically significantly shorter in the SuperPath group than the conventional posterior group at 1 week, 1 month and 3 months after surgery:

    • 1 week: TUG, 2.06±1.43 minutes compared with 3.2±1.47 minutes, p=0.002; TSC, 5.34±1.85 minutes compared with 7.2±2.04 minutes, p=0.000

    • 1 month: TUG, 1.33±0.36 minutes compared with 2.57±0.59 minutes, p=0.016; TSC, 2.56±0.78 minutes compared with 3.47±0.83 minutes, p=0.022

    • 3 months: TUG, 0.92±0.10 minutes compared with 1.2±0.23 minutes, p=0.036; TSC, 1.96±0.69 minutes compared with 2.21±0.55 minutes, p=0.041.

    The differences were not statistically significant at 1 year between the 2 groups (TUG, 0.52±0.12 minutes compared with 0.58±0.09 minutes, p=0.70; TSC, 1.06±0.13 minutes compared with 1.09±0.19 minutes, p=0.55; (Xie 2017).

    In the randomised controlled trial of 44 patients, preoperative gain velocity was 3.02±0.72 km/h in the SuperPath group compared with 2.92±0.85 km/h in the mini posterior group (p=0.66). At 6 weeks after operation, gain velocity was 3.00±0.92 km/h compared with 2.69±1.00 km/h (p=0.28). Comparison of the mean differences between preoperation and 6 weeks postoperation did not found statistically significant difference between the 2 groups (p=0.06; Korytkin 2021).

    Improvement in quality of life

    SF-12

    In the non-randomised comparative study of 90 patients, the mean SF-12 physical and mental scores were statistically significantly higher in the SuperPath group than the posterior group at 1 year after surgery (SF-12 physical, 88.6±10.5 compared with 79.0±13.5, p=0.04; SF-12 mental, 85.6±12.0 compared with 76.1±15.3, p=0.02). The differences at 3 and 6 months were not statistically significantly different:

    • SF-12 physical score at 3 months: 82.4±13.7 compared with 85.5±13.5, p=0.95

    • SF-12 mental score at 3 months: 82.7±12.4 compared with 81.8±14.2, p=0.92

    • SF-12 physical score at 6 months: 85.5±13.6 compared with 86.3±13.0, p=0.50

    • SF-12 mental score at 6 months: 84.7±15.4 compared with 82.6±14.4, p=0.57.

    When comparing with preoperative values, the mean SF-12 physical and mental scores statistically significantly improved at 1-year follow up in both groups (SF‑12 physical: SuperPath, 39.8±12.3 compared with 88.6±10.5, p<0.001; posterior, 41.7±12.6 compared with 79.0±13.5, p<0.001; SF-12 mental: SuperPath, 46.1±13.7 compared with 85.6±12.0, p<0.001; posterior, 47.6±14.7 compared with 76.1±15.3, p<0.001; Mas Martinez 2019).

    iHOT-12

    In the non-randomised comparative study of 90 patients, the mean iHOT-12 score was statistically significantly higher in the SuperPath group than the posterior group at 3 months postoperation (78.2±15.6 compared with 63.5±22.8, p=0.04) but not at 6 months (76.0±24.8 compared with 70.6±22.5, p=0.74) and 1 year (78.5±18.3 compared with 76.8±14.9, p=0.53). When comparing with preoperative values, the mean iHOT-12 scores statistically significant increased at 1 year in both groups (SuperPath, 15.2±15.1 at baseline compared with 78.5±18.3 at 1 year, p<0.001; posterior, 22.2±18.7 at baseline compared with 76.8±14.9 at 1 year, p<0.001; Mas Martinez 2019).

    Implant position

    In the randomised controlled trial of 92 patients, radiographic evaluation revealed that the mean cup anteversion angle was 17.4±1.6 degrees in the SuperPath group compared with 18.5±1.8 degrees in the conventional posterior group (p=0.23), and that the mean cup abduction angle was 43.6±6.8 degrees compared with 44.5±6.5 degrees (p=0.41). Stem alignment was neutral in 43% of patients in the SuperPath group and 44% in the conventional posterior group (p=0.21; Xie 2017).

    In the randomised controlled trial of 40 patients, postoperative radiographs showed that the mean cup abduction angle in the SuperPath group was significantly smaller than the posterolateral group (36.94±6.37 degrees compared with 42.66±3.58 degrees, p=0.004) and that the mean cup anteversion angles between the groups were comparable (13.94±4.73 degrees compared with 15.11±4.06 degrees, p=0.501; Meng 2021).

    In the randomised controlled trial of 44 patients, postoperative radiographs showed that the mean cup anteversion and inclination were 18o and 43o in the SuperPath group, and 19 degrees and 44 degrees in the mini posterior group. Stem alignment was neutral in 100% of patients in the SuperPath group and 96% in the mini posterior group. No statistically significant differences were reported between the 2 groups (Korytkin 2021).

    In the non-randomised comparative study of 90 patients, there was no statistically significant difference in the mean angle of acetabular inclination between the SuperPath group and the posterior group at 3 months after surgery (47.6o compared with 45.9o, p=0.41). All the femoral stems were implanted in neutral position (Mas Martinez 2019).

    In the non-randomised comparative study of 99 patients, postoperative radiographic outcomes showed that cups in the SuperPath group were statistically significantly more anteverted (23.5±8.2 degrees) and less abducted (39.0±8.4 degrees) than cups in the PATH group (13.1±7.1 degrees and 42.9±7.6 degrees, respectively; all p<0.05; Rasuli 2015).

    In a case series of 150 patients with osteoarthritis of the hip, the mean inclination angle was 39.3 degrees (range 28 to 50 degrees) and there was no leg length difference more than 5 mm. The mean anteversion angle was 17.1 degrees (range 6.2 to 31.9 degrees, SD=4 degrees) measured at a standard supine anteroposterior pelvis view, and the position of the stem was 0.17 degrees varus (range 2.7 degrees valgus to 3.3 degrees varus, SD=0.9 degrees) measured between the stem axis and the long axis of the femur. There was no radiological loosening of the components after a mean follow up of 16 months (Qultmann 2019).

    Length of hospital stay

    In the randomised controlled trial of 92 patients, the mean length of hospital stay was statistically significantly shorter in the SuperPath group than the conventional posterior group (8.3±3.6 days compared with 11.4±2.4 days, p=0.000; Xie 2017).

    In the randomised controlled trial of 40 patients, the mean length of hospital stay was 3.00±0.00 days in the SuperPath group compared with 2.72±0.57 days in the posterolateral group (p=0.161; Meng 2021).

    In the randomised controlled trial of 44 patients, the mean length of hospital stay was 8.85±1.66 days in the SuperPath group compared with 8.66±1.63 days in the mini posterior group (p=0.35; Korytkin 2021).

    In a non-randomised comparative study of 99 patients with degenerative hip arthritis, the mean length of hospital stay was statistically significantly shorter for patients who had THA using the SuperPath approach than patients who had THA using the PATH approach (2.2±0.9 days compared with 3.0±0.8 days, p<0.0001; Rasuli 2015).

    In the case series of 150 patients, the length of stay at hospital was 9.9 days because of the regulations of the hospital and most of patients were able to go home earlier (Qultmann 2019).

    Postoperative pain

    In the randomised controlled trial of 92 patients, the mean VAS scores (a scale of 0 [no pain] to 10 [worst imaginable pain]) were statistically significantly lower for patients who had THA using the SuperPath approach than patients who had THA using the conventional posterior approach at 1 week (4.86±0.83 compared with 6.53±0.52, p=0.000) 1 month (2.6±0.82 compared with 3.4±0.63, p=0.009) and 3 months (1.4±0.63 compared with 1.87±0.74, p=0.048) postprocedure. The difference in pain was not statistically significant at 1 year between the 2 groups (0.87±0.51 compared with 0.97±0.35, p=0.16; Xie 2017).

    In the randomised controlled trial of 40 patients, the mean VAS score was statistically significantly higher for patients who had THA using the SuperPath approach than patients who had THA using the posterolateral approach at postoperative day 3 (7.05±0.72 compared with 6.55±0.70, p=0.041). However, the differences between the 2 groups at postoperative day 1 (7.38±0.77 compared with 6.94±0.72, p=0.097), day 14 (5.00±1.02 compared with 4.44±0.92, p=0.097), month 3 (1.77±0.80 compared with 1.55±0.85, p=0.372), month 6 (0.66±0.68 compared with 0.72±0.57, p=0.743) and month 12 (0.05±0.23 compared with 0.11±0.32, p=0.791) were not statistically significant. In both groups, pain VAS reached its minimum plateau between 3 and 12 months postoperatively (Meng 2021).

    In the randomised controlled trial of 44 patients, the mean VAS score was statistically significantly lower for patients who had THA using the SuperPath approach than patients who had THA using the posterolateral approach at 6 weeks postoperation (0.85±0.58 compared with 1.87±1.2, p=0.001). There was no statistically significant difference between the 2 group preoperatively (5.7±2.03 compared with 5.4±1.81, p=0.63; Korytkin 2021).

    In the non-randomised comparative study of 90 patients, the mean WOMAC pain scores were not statistically significantly different between the SuperPath and posterior groups at 3-month (87.2±14.1 compared with 85.8±16.1, p=0.49), 6‑month (96.2±12.5 compared with 92.7±12.9, p=0.57) and 1-year (97.0±11.6 compared with 91.2±12.8, p=0.42) follow ups. When comparing with preoperative values, pain was statistically significant worse at 1-year follow up in both groups (SuperPath, 38.2±14.6 at baseline compared with 97.0±11.6 at 1 year postoperation, p<0.001; posterior, 41.3±12.9 at baseline compared with 91.2±12.8 at 1 year postoperation, p<0.001; Mas Martinez 2019).