https://doi.org/10.1007/s00132-011-1895-2. Marta says: December 11, 2013 at 7:12 am . There was no difference between the conventional approach group and the SuperPATH group, concerning the pain VAS 1 day postoperatively (MD = − 0.89, 95% CI − 2.96 to 1.19, I2 = 85%, p = 0.27, Fig. The Harris Hip Score (HHS) was developed for assessment of the results of hip surgery [65]. Cheng T, Feng JG, Liu T, Zhang XL. 22(19):2953–60 Article in Chinese. 2013;471(4):1283–94. Three hundred and forty-six of the included patients were operated via SuperPATH approach and 380 of the included patients were operated via conventional approaches. Published 2013 Nov 12. doi:10.1371/journal.pone.0080021. Preferred Reporting Items for Systematic reviews and Meta-Analyses: the PRISMA statement. October 16, 2017 John Walsh. 8). Total hip arthroplasty: minimally invasive surgery or not? The incision used in this posterolateral approach, as it is called, is about six to nine inches long and is made along the side of the hip and the upper thigh. Oñativia IJ, et al. Deutsches Ärzteblatt. https://doi.org/10.1371/journal.pone.0037947. I personally think that the rate of recovery between my anterior approach hip replacements and my superpath approach hip replacements are very similar. Li N, Deng Y, Chen L. Comparison of complications in single-incision minimally invasive THA and conventional THA. https://doi.org/10.1016/j.aott.2017.07.006. The two approaches did not differ in acetabular cup positioning angles, intra- and postoperative blood loss, hospitalization period, and postoperative complications. In general, there is no consensus in literature regarding a superiority of minimally invasive approaches compared to conventional approaches [31,32,33,34,35,36,37,38]. With the world population aging, the number of hip joint pathologies increases [1, 2]. PubMed Central  SG, SuperPATH approach group; CG, conventional approach group; IV, inverse variance; CI, confidence interval; HHS, Harris Hip Score; post-op, postoperatively, Comparison of the acetabular cup positioning angle in degrees in SuperPATH approach and conventional approach groups. Pain VAS 1 day postoperatively Data on 222 patients (including 98 patients with SuperPATH approach and 124 patients with conventional approaches) were pooled from 4 RTCs analyzing the pain VAS 1 day postoperatively. The meta-analysis by Li found better results in hip replacement via SuperPATH approach with 98.4 ml less postoperative drainage volume compared to hip replacement via conventional approaches [59]. Study weighting was performed by inverse variance or Mantel-Haenszel method [74, 75]. PubMed  Clin Geriatr Med. Instr Course Lect. PATH® Total Hip Replacement Approach Key aspects Preserves Iliotibial Band, Quadratus Femoris and Obturator Externus ... SuperPath® hip approach. 2009;33(6):1473–81. California Privacy Statement, Hip replacement via SuperPATH approach had a longer operation time than hip replacement via conventional approaches. 2006;35:738–43. J Orthop Surg Res 15, 420 (2020). https://doi.org/10.7507/1002-1892.201807011 Article in Chinese. Factors that influence the complications and outcomes of femoral neck fractures treated by cannulated screw fixation. A systematic literature search up to April 2020 was performed to identify randomized controlled trials comparing SuperPATH with conventional approaches in hip joint replacement. There was no difference between the conventional approach group and the SuperPATH group, concerning the pain VAS 12 months postoperatively (MD = − 0.09, 95% CI − 0.32 to 0.13, I2 = 0%, p = 0.22, Fig. 2019;80(6):320–4. J Hebei Med Univ. 31(1):17-24. Mean differences or odds ratios with 95% confidence intervals were calculated and pooled using random effects models and the Hartung-Knapp-Sidik-Jonkman method. Zhang Y, Jordan J. 1969. Minimally invasive THA was developed to provide improvement [11]. We calculated the odds ratio (OR) and their 95% confidence intervals (CIs) for dichotomous outcomes. The incision length in hip replacement via SuperPATH approach was 4.8 cm shorter compared to hip replacement via conventional approaches. 2016;34(03):289–92 Article in Chinese. 2007. http://mediatum.ub.tum.de/doc/624545/file.pdf. Cochrane, 2019. Several approaches to the hip joint have been described and modified by various authors. 2012;7(5):e37947. The other Chinese meta-analysis by Li, however, found better results in hip replacement via SuperPATH approach with 4.3 more points compared to hip replacement via conventional approaches at 3 months postoperatively. These studies were published between 2016 and 2020, altogether involving 726 patients (with 749 operated hip joints). 2006;35:716–22. Chen C, et al. 8). Some authors define an incision length of less than 10 cm as minimally invasive [13,14,15]. Hip Int. Open access funding provided by Projekt DEAL. 2006;30:160–71. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Dake Y, He Q, Kang L, Chen D, Wenbin D, Hao Z, et al. Sci Rep. 2020;10:758. https://doi.org/10.1038/s41598-020-57696-2. The only muscle structure occasionally released during the superior approach (also called the “supercap”, short for superior capsulotomy) – the piriformis tendon, is repaired in its natural position. Figure 2 shows the summarized assessment for risk of bias in a risk of bias summary and a risk of bias graph. Zwinderman AH, Bossuyt PM. 6). 2008;27:687–97. https://doi.org/10.5301/hipint.5000532. https://doi.org/10.1007/s11999-012-2717-5. I’ve also seen this described as a Northern, a micro posterior, a direct posterior, or a direct lateral approach to address copyright issues. Article  We assessed clinical and statistical heterogeneity. RS and RK checked the final version. Gerlinger TL, Ghate RS, Paprosky WG. The aim of this systematic review and meta-analysis was to compare the short-term outcome of SuperPATH minimally invasive approach and conventional approaches in hip replacement for treatment of hip joint diseases and fractures, including only quality RCTs. Orthopade. There was no difference between the conventional approach group and the SuperPATH group, concerning the hospitalization period (MD = − 2.80, 95% CI − 6.61 to 1.02, I2 = 96%, p = 0.10, Fig. Ren Dongwei, Yang Gejun, Zhao Hualei, et al. Article  Joined Jan 4, 2013 Messages 1,041 Age 63 Location … 2015;27(4):334–41. J Orthop Surg Res. J Clin Rehabilit Tissue Eng Res. Moreau P. Minimally invasive total hip arthroplasty using Hueter’s direct anterior approach. 3Goulding K, Beaule PE, Kim PR, Fazekas A, Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty, Clin Orthop Relat Res (2010) Sept; 468(9);2397-2404. Comparison of effectiveness between SuperPATH approach and posterolateral approach in total hip arthroplasty. PubMed Central  Harris WH. The SuperPATH approach was introduced and reported by James Chow in 2011 [39]. https://doi.org/10.7507/1002-1892.201707121 Article in Chinese. A systematic review and meta-analysis of the standard versus mini-incision posterior approach to total hip arthroplasty. 2020;12(1):74–85. 2Bhargava T, Goytia RN, Jones LC, Hungerford MW, Lateral femoral cutaneous nerve impingement after direct anterior approach for total hip arthroplasty, Orthopedics (2010) Jul 13;33(7):472. 2010;36(3):1–48. Compared with conventional approach group, the frequency of risk for postoperative complications was lower in the SuperPATH group (OR = 0.83, 95% CI 0.12 to 5.98, I2 = 37%, p = 0.81, Fig. Szendroi M, Sztrinkai G, Vass R, Kiss J. Randomized controlled trial of comparison between the SuperPATH and posterolateral approaches in total hip arthroplasty. 2010 Aug;26(3):355–69. https://doi.org/10.1016/S0140-6736(18)31665-9. It’s been six months since Marty’s minimally invasive hip replacement surgery. Most offer a bundled rate that includes the facility, anesthesia, medications, walker, surgeon. Visual analogue scale (VAS). SuperPATH approach showed better results in decreasing incision length and early pain intensity as well as improvement of short-term functional outcome. There was no difference between the conventional approach group and the SuperPATH group, concerning the HHS 3 months postoperatively (MD = 1.64, 95% CI − 2.91 to 6.19, I2 = 95%, p = 0.42, Fig. Ouyang C, Wang H, Meng W, Luo Z, Wang D, Pei F, et al. Anterior hip replacement may provide some benefits in terms of speeding the early recovery timeline, although even this is a subjective debate. 2015;30:945–9. This technique is also referred to as the Northern Approach or Northern Exposure. SG, SuperPATH approach group; CG, conventional approach group; IV, inverse variance; CI, confidence interval, Comparison of the pain VAS 1, 3, 7 days, 3 and 12 months postoperatively in SuperPATH approach and conventional approach groups. Outcomes of nondisplaced intracapsular femoral neck fractures with internal screw fixation in elderly patients: a systematic review. Ann Transl Med. The other Chinese meta-analysis by Sun showed indifferent operation times for both groups [60]. 2004;35:137–42. China Tissue Eng Res. 109 replies. Orthopedics. Patients can also have as little as a 3-inch incision. 9). J Trad Chin Orthop. Numerous studies on the outcome of femoral neck fractures, operated by a head-preserving method, showed a high risk for osteosynthesis failure, in some cases > 40% [3,4,5,6,7,8]. Human participants with hip disease or hip fracture, THA and HA via SuperPATH and conventional approaches, Employment of a computer navigation system. Thank you for this! Zhejiang J J Traumatic. Q&A: Total hip replacement, mini-posterior vs. direct anterior surgical approaches. In statistical calculations the SuperPATH approach group was “experimental group” and the conventional approach group was the “control group”. Tripuraneni KR, Munson NR, Archibeck MJ, Carothers JT. Anterior Approach versus SuperPATH or Superior Approach in Total Hip Arthroplasty. The 2013 meta-analysis by Xu did not show differences in postoperative administration of pain medication between hip replacement via mini-incision and conventional approaches [36]. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Ilchmann T. Approaches for primary total hip replacement. https://doi.org/10.1007/s00590-018-2158-2. Research recently presented at a meeting of orthopaedic specialists shows that patients often fare no better with minimally invasive hip replacement than those having a standard hip replacement -- and may do worse. The main preoperative diagnoses were osteoarthritis, femoral neck fracture, and avascular necrosis of the femoral head. Table 2 shows the main characteristics of the 12 included RCTs. Metal-on-metal hip resurfacing is done in a similar way, however this is rarely done now because of possible complications and a higher "failure rate". Otherwise the pooled effect sizes, as well as 95% confidence intervals [CIs], were calculated with both the Hartung-Knapp-Sidik-Jonkman method and the DerSimonian and Laird method, using both fixed and random effects models to estimate the variance of the distribution of true effect sizes. Sep 25;12(1):138 DOI: https://doi.org/10.1186/s13018-017-0636-6. There was no difference between the conventional approach group and the SuperPATH group, concerning the HHS 14 days postoperatively (MD = − 1.88, 95% CI − 24.88 to 21.13, I2 = 73%, p = 0.76, Fig. We did not pool study data that were clinically too diverse. Anterior hip replacement is a common type of total hip replacement. Acta Orthop Traumatol Turc. 2014;24 Suppl 10:S2-S6. J Nanjing Med Univ (Natural Sciences). Chapter 10: Analysing data and undertaking meta-analyses. Percutaneously assisted total hip (PATH). In elderly patients with femoral neck fractures, artificial hip replacement should be considered [8]. 2018;28(5):771–9. Privacy Additional physical therapy is not required. Part of [36]. Epidemiology of osteoarthritis. https://doi.org/10.3928/01477447-20120725-12. The impact of minimally invasive total hip arthroplasty on the standard procedure. Nikolai Ramadanov. SuperPATH approach showed better results in decreasing incision length and early pain intensity as well as improvement of short-term functional outcome. The results of the THA-subgroup did not differ from the overall effect in a clinically relevant manner. Data on 407 patients (including 186 patients with SuperPATH approach and 221 patients with conventional approaches) were pooled from 6 RTCs analyzing the postoperative complications. Long-term outcomes of SuperPATH approach need to be investigated. Postoperative complications such as venous thrombosis of lower extremities, implant loosening, infection, periprosthetic fracture, or dislocation were investigated. In a posterior approach, the patient lays on their stomach during the procedure and the … 6). Data on 630 patients (including 298 patients with SuperPATH approach and 332 patients with conventional approaches) were pooled from 10 RTCs analyzing the operation time. 5). https://doi.org/10.1007/s00264-018-4124-3. 3, 4, 5, 6, 7, 8, 9, and 10). We measured surgical, functional, and radiological outcomes. No dislocation performed so muscles, tendons, and capsule are only minimally stretched during removal of the cut femoral head. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. SG, SuperPATH approach group; CG, conventional approach group; IV, inverse variance; CI, confidence interval, Comparison of the intraoperative blood loss and the postoperative drainage volume in ml in SuperPATH approach and conventional approach groups. Advances in surgical technology have improved the longevity and recovery time for total hip replacement. BMC Musculoskelet Disord. https://doi.org/10.1016/j.ocl.2009.05.001. Furthermore, we compared the results with a 2013 meta-analysis with 1174 included patients on hip replacement via mini-incision approaches versus hip replacement via conventional approaches by Xu et al. A SuperPath® Hip Replacement is designed to precisely reconstruct the hip without cutting critical tendons and stretching or traumatizing muscles that are important to hip function. Springer Nature. Available from www.training.cochrane.org/handbook. Pain VAS 3 days postoperatively Data on 222 patients (including 98 patients with SuperPATH approach and 124 patients with conventional approaches) were pooled from 4 RTCs analyzing the pain VAS 3 days postoperatively. There was no difference between the conventional approach group and the SuperPATH group, concerning the HHS 12 months postoperatively (MD = 0.64, 95% CI − 0.36 to 1.64, I2 = 0%, p = 0.13, Fig. Orthop Clin North Am. SG, SuperPATH approach group; CG, conventional approach group; MH, Mantel-Haenszel; CI, confidence interval. IntHout J, Ioannidis JP, Borm GF. It is the first meta-analysis comparing the SuperPATH approach with conventional approaches to the hip joint in English language. This is described as a “superPATH” technique, or superior capsulotomy percutaneously assisted total hip. 8). Accessed 28 July 2020. There was no difference between the conventional approach group and the SuperPATH group, concerning the postoperative drainage volume (MD = − 75.16, 95% CI − 200.22 to 49.90, I2 = 100%, p = 0.15, Fig. SG, SuperPATH approach group; CG, conventional approach group; IV, inverse variance; CI, confidence interval, Comparison of postoperative complications in SuperPATH approach and conventional approach groups. A Chinese-speaking reviewer (KL) helped with the search in CNKI. We calculated mean differences (MDs) with 95% CIs for continuous outcomes. Clarivate Analytics. No Difference in Dislocation Seen in Anterior Vs Posterior Approach Total Hip Arthroplasty. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng H-Y, Corbett MS, Eldridge SM, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT. The SuperPATH hip replacement technique is the creation of Dr. Jimmy Chow of the Orthopedic Institute of the West. 2003;34:529–32. While English literature on this subject appears sparse [40,41,42], most of the studies are published in Chinese [43,44,45,46,47,48,49,50,51,52,53,54,55,56,57]. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). We calculated the t test to determine statistically significant differences between the means of the two groups. There is a variation of the “supercap” approach were a portal is used for acetabular reaming. Correspondence to Lastly, only one study reported sufficient blinding, which might affect the final outcomes. The limitations to this meta-analysis are as follows: First, the long-term outcomes of SuperPATH approach were not considered. 2019;393:647–54. Super⁃Path artificial minimally invasive hip replacement for elderly patients with femoral neck fractures. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. The quality of the included studies was assessed by the Cochrane Collaboration’s tool for risk of bias. Artificial total hip arthroplasty (THA) is applied since the 1920s. The results of the THA-subgroup did not differ from the overall effect in a clinically relevant manner. Effect of SuperPath minimally invasive incision total hip arthroplasty on femoral head necrosis and the quality of life. PubMed  HHS 7 days postoperatively Data on 246 patients (including 121 patients with SuperPATH approach and 125 patients with conventional approaches) were pooled from 4 RTCs analyzing the HHS 7 days postoperatively. 2008;23:55–8. https://doi.org/10.1016/j.arth.2014.05.021. 10, 67434, Neustadt, Germany, Center for Surgery, Evangelical Hospital Ludwigsfelde-Teltow, Albert-Schweizer-Str. Gangyong H, Jun X, Yibing W, Wang S, Wu J, Feiyan C, et al. This study involves comparing the outcomes after using the Direct Anterior Approach (DAA) and the Supercapsular Percutaneously Assisted Total Hip (SuperPATH) approach. The reamer shaft is passed through the cannula and is mated with the acetabular reamers inside the capsule. Measurement of pain. Like the anterior hip replacement surgery, the SuperPATH procedure has no restrictions and no precautions. Swanson TV. Oper Orthop Traumatol. Google Scholar. https://doi.org/10.3969/j.issn.2095-4344.2017.07.005 Article in Chinese. The incision length (in centimeters) was measured on graduated scale. The acetabular cup anteversion angle and (b) the inclination angle (in degrees) have ideal values for positioning: anteversion angle from 10 to 25° and inclination angle from 40 to 50° [66]. Mahmood A, Zafar MS, Majid I, Maffulli N, Thompson J. Minimally invasive hip arthroplasty: a quantitative review of the literature. This site complies with the HONcode standard for trustworthy health information: Verify Here. 1974;2:1127–31. 67, 75179, Pforzheim, Germany, Department for Orthopaedics, Trauma Surgery and Sports Traumatology, Marienhaus Hospital Hetzelstift, Stiftstr. Quantifying heterogeneity in a meta-analysis. Cardenas NC, Bellotti V, Astarita E, et al. In general, our meta-analysis indicated that hip replacement via SuperPATH approach was superior to hip replacement via conventional approaches regarding the investigated outcomes. We evaluated the results and analyzed them on basis of the Cochrane Handbook for Systematic Reviews of Interventions [70], Cochrane’s Review Manager Version 5.3 [67], and the R packages meta [71] and metafor [72]. The two approaches for hip replacement did not differ in acetabular cup positioning angles, intra- and postoperative blood loss, hospitalization period, and postoperative complications. It correlates with the competence of the surgeon in these two different approaches as well as risk of infection. Xu G, Hu L, Yang S. Short-term follow-up study of superpath minimally invasive approach in artificial femoral head replacement for senile femoral neck fractures. Our meta-analysis did not find any differences in the acetabular cup positioning angles, neither in anteversion nor in inclination, in hip replacement via SuperPATH approach compared with conventional approaches. The postoperative drainage volume (in milliliters) was defined as the total amount of blood collected in the drainage bag. Since long-term outcomes improved, there is still room for improvement in early postoperative recovery. “Technique of tissue-preserving, minimally-invasive total hip arthroplasty using a superior capsulotomy.” Operative Techniques in Orthopaedics 14.2 (2004): 94-101.http://www.stephenmurphy.org/hip/hminimally/101-107.PDF, http://www.stephenmurphy.org/hip/hminimally/murphy%20tissue%20preserving%20tha.pdf. Comparison of supercapsular percutaneously assisted approach total hip versus conventional posterior approach for total hip arthroplasty: a prospective, randomized controlled trial. They found better results in hip replacement via mini-incision approaches with 111.5 ml less intraoperative blood loss compared to hip replacement via conventional approaches. A 1-year prospective outcome study of 275 patients. The early HHS at 7 days postoperatively was 10.2 higher in hip replacement via SuperPATH approach compared to hip replacement via conventional approaches. Comparison of early complications between the use of a cannulated screw locking plate and multiple cancellous screws in the treatment of displaced intracapsular hip fractures in young adults: a randomized controlled clinical trial. Clinical research on joint function and life quality through SuperPath approach in total hip arthroplasty. 2017;20(1):50–3 Article in Chinese. RoB 2: a revised tool for assessing risk of bias in randomised trials. There was no difference between the two approaches 1 and 6 months postoperatively [59]. Chinese National Knowledge Infrastructure (CNKI). 2019. Eur J Orthop Surg Traumatol. 2017;22(02):343–5 Article in Chinese. Thereafter, the femur is broached and osteotomy of the femoral neck is performed. The cost-utility of total hip arthroplasty: earlier intervention improved economics. :D . Pain VAS 7 days postoperatively Data on 348 patients (including 160 patients with SuperPATH approach and 188 patients with conventional approaches) were pooled from 4 RTCs analyzing the pain VAS 7 days postoperatively. https://doi.org/10.1111/os.12584. SuperPATH minimally invasive approach to total hip arthroplasty of femoral neck fractures in the elderly: preliminary clinical results. Hainan Med J. Ten out of 19 measured outcomes showed a high statistical heterogeneity (> 75%), four out of 19 measured outcomes showed a moderate statistical heterogeneity (25–75%), and 5 out of 19 measured outcomes showed a low statistical heterogeneity (< 25%) (see Figs. Over the last decades, several minimally invasive approaches and techniques have been introduced [20,21,22,23,24,25,26,27,28,29,30]. sandybeach post-grad. The hospitalization period (in days) was the time period from admission to discharge of the patient. I began using the superior approach for total hip replacement in February of 2014. PLoS One. 2007;65(1):5–18. This is a modification of the anterior and posterior approaches to the hip (its essentially an anterolateral hip approach deep but superficially the hip capsule is approached posterior to the gluteus medius and minimus). J Arthroplast. With SuperPath®, there is no surgical dislocation of the hip. 51:737–55. Wu L, Yu B, Chen FC. The subsequent HHS at 14 days, 1, 3, 6 and 12 months postoperatively were almost equal in both groups. https://doi.org/10.3969/j.issn.2095-4344.0194 Article in Chinese. Br J Hosp Med (Lond). In addition, the confounding of hemiarthroplasty (HA) [48] and THA as well as conventional and mini-incision approaches [56] poses another severe limitation to this meta-analysis [59]. The hip replacement operation has become a routine procedure. Pain VAS 3 months postoperatively Data on 182 patients (including 90 patients with SuperPATH approach and 92 patients with conventional approaches) were pooled from 4 RTCs analyzing the pain VAS 3 months postoperatively. We searched the following databases and checked citations of screened studies and reviews for relevant manuscripts. Pain VAS 12 months postoperatively  Data on 120 patients (including 60 patients with SuperPATH approach and 60 patients with conventional approaches) were pooled from 3 RTCs analyzing the pain VAS 12 months postoperatively. Cases of disagreement were resolved by discussion and consensus with a third reviewer (RK). 2018;52:89–97. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

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