Assessment of the Learning Curve of Supercapsular Percutaneously Assisted Total Hip Arthroplasty in an Asian Population

Abstract

The supercapsular percutaneously assisted total hip (SuperPATH) approach is a microinvasive approach that was developed to minimize surgical disruption of soft tissue during routine total hip arthroplasty (THA). This study was aimed at assessing early outcomes and learning curves of the SuperPATH approach in one Chinese hospital’s experience. Early outcomes of the first consecutive 78 SuperPATH cases (80 hips) performed by the same surgeon were evaluated. The patients were divided into 4 groups according to the surgical order. The incision, intraoperative blood loss, hospital stay, Harris hip score, and complication occurrence in each group were evaluated. Learning curves were assessed using operative time and intraoperative blood loss as surrogates. The operation time and intraoperative blood loss of groups A and B were more than those of groups C and D, and the difference was statistically significant (P<0.05); however, there was no statistically significant difference between the two groups (group A vs. group B, P=0.426; group A vs. group B, P=0.426). There was no statistically significant difference in terms of incision length and hospital stay, and Harris hip score at the last follow-up was increased with statistically significant difference when compared with that preoperatively among the 4 groups. One case of periprosthetic fracture occurred in group A. No other complication, such as joint dislocation, sciatic nerve injury, prosthesis loosening, periprosthetic infection, and deep vein thromboembolism, occurred in the 4 groups. In summary, for surgeons who are familiar with the standard posterolateral approach, they could achieve more familiarity with SuperPATH after 40 cases of surgery.

The Supercapsular Percutaneously Assisted Total Hip (SuperPATH) Approach Revisited: Technique Improvements after the Perioperative Experience of 344 Cases

“…We noticed that after the first 50 cases (i.e., learning curve), the primary surgeon and the whole surgical team felt more comfortable with the approach. This number of cases as a learning curve is consistent with the literature [ 2 ], as the primary surgeon and the team were familiar with both the PATH and the classic posterolateral approaches.…”

“…There have been a plethora of large clinical studies that have shown excellent results from all these main classical methods of THA [4]. However, issues regarding pain control, Life 2022, 12, 981 2 of 9 length of postoperative rehabilitation, and complications from the surgical approach resulted in modifications that improved those traditional approaches to become more tissue friendly [2].…”

“…An effective method to manage hip osteoarthritis has been total hip arthroplasty (THA). THA, one of the most reproducible and frequently performed orthopedic surgical procedures, also provides effective treatment for disorders such as femoral neck fracture, femoral head necrosis, and acetabular dysplasia [ 1 , 2 ]. This operation has increasingly gained popularity amongst surgeons, because it relieves pain effectively and is associated with early mobilization and improved life quality among patients [ 3 ].…”

“…More commonly used modifications currently include the direct anterior approach (DAA), the anterior supine intermuscular approach (ASI or OCM), and the modified mini-posterior approach. Each of these MIS approaches has been shown to be safe and effective when the period of its “learning curve” is over [ 2 ]. This learning curve period has been reported to differ based on approach, author, and patient population [ 7 , 8 ].…”

Radiographic results on acetabular cup placement with the SuperPath technique: a retrospective study of 756 cases

“…Among the several MIS, the Supercapsular percutaneously assisted total hip (SuperPath) (MicroPort Orthopedics Inc., Arlington, TN, USA) is a minimally invasive technique that utilizes a muscle-sparing surgical approach between the piriformis and gluteus minimus muscles, preserving the insertion of the extrarotator muscles, the posterior capsule, and avoiding the surgical dislocation of the femoral head [ 21 ]. Several benefits were attributed to its use such as tissues preservation, early postoperative recovery from the pain, short incision length, short hospitalization, early recovery of daily activities, less perioperative blood loss and a lower transfusion [ 22 – 26 ]. There is not yet a large radiographic case series in the literature regarding acetabular cup placement in THAs via the SuperPath technique.…”