Department of Orthopaedics, West China Hospital, West China School of Medicine, Sichuan University, No. 37, Wuhou Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China.
Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Strasse, Building 37, D-66421, Homburg, Saarland, Germany.
BMC Musculoskelet Disord. 2019 Dec 31;21(1):2. doi: 10.1186/s12891-019-3023-0.
The supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA). Here, we compared the short-term outcomes of staged THA with the SuperPath or through posterolateral approach (PLA) for bilateral osteonecrosis of the femoral head (ONFH).
Patients with bilateral late-stage ONFH were prospectively recruited from our department from March 2017 to March 2018. Staged bilateral THAs with one side SuperPath and the other side PLA were performed consecutively in the same patients with right and left hips alternating within approaches. The average time interval between the staged THAs was 3 months. Perioperative status (operation time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay) and postoperative function (range of motion, pain, and hip function) were recorded and compared between the SuperPath and PLA approaches within 12-month postoperatively.
Four male patients (age, 51.00 ± 4.54; BMI, 21.49 ± 1.73) with bilateral alcohol-induced ONFH (Ficat III/IV) were followed up over 12 months postoperatively. Compared with the PLA, the SuperPath yielded shorter incision length (7.62 vs. 11.12 cm), longer operation time (103.25 vs. 66.50 min), more blood loss (1108.50 vs. 843.50 ml), deficient abduction angle of the acetabular cup (38.75° vs. 44.50°), and inferior early-term hip function (Harris hip score, 72.50 vs. 83.25) at 12-month postoperatively. Soft tissue damage, length of hospital stay, postoperative pain, postoperative range of motion, and 12-month patient satisfaction were comparable between both approaches.
The SuperPath may be a minimally invasive technique but the present study shows less favorable short-term outcomes than PLA for total hip arthroplasty in osteonecrosis of the femoral head. More investigations are required to provide convincing favorable evidences of the SuperPath over other traditional THA approaches.
The trial was retrospectively registered in https://www.researchregistry.com (No. Researchregistry4993) on July 04, 2019. The first participant was enrolled on March 13, 2017.
经皮辅助的囊外全髋关节置换术（SuperPath）被认为具有微创和组织保护的特点，与传统全髋关节置换术（THA）相比，术后结果可能更好。在这里，我们比较了 SuperPath 与后外侧入路（PLA）治疗双侧股骨头坏死（ONFH）的短期疗效。
我们从 2017 年 3 月至 2018 年 3 月从我们的科室前瞻性地招募了双侧晚期 ONFH 患者。连续对这些患者进行双侧分期 THA，一侧采用 SuperPath，另一侧采用 PLA，右髋和左髋在同侧采用交替的方法。分期 THA 的平均时间间隔为 3 个月。记录和比较 SuperPath 与 PLA 入路在术后 12 个月内的围手术期情况（手术时间、切口长度、术中失血量、软组织损伤和住院时间）和术后功能（活动范围、疼痛和髋关节功能）。
4 名男性患者（年龄 51.00±4.54 岁，BMI 21.49±1.73），双侧酒精性 ONFH（Ficat III/IV），随访超过 12 个月。与 PLA 相比，SuperPath 具有更短的切口长度（7.62 比 11.12cm）、更长的手术时间（103.25 比 66.50min）、更多的出血量（1108.50 比 843.50ml）、髋臼杯外展角不足（38.75°比 44.50°）和早期髋关节功能较差（Harris 髋关节评分，72.50 比 83.25）。在术后 12 个月时，软组织损伤、住院时间、术后疼痛、术后活动范围和 12 个月患者满意度在两种方法之间无差异。
SuperPath 可能是一种微创技术，但本研究表明，在股骨头坏死的全髋关节置换术中，SuperPath 的短期结果不如 PLA。需要进一步的研究为 SuperPath 提供比其他传统 THA 方法更有说服力的有利证据。
该试验于 2019 年 7 月 4 日在 https://www.researchregistry.com（注册号：Researchregistry4993）进行了回顾性注册。第一个参与者于 2017 年 3 月 13 日入组。
