Flevas Dimitrios A, Tsakotos Georgios A, Benakis Leonardos N, Sasalos Grigorios G, Tokis Anastasios V
Arthroscopy and Orthopaedic Surgery Department, Metropolitan Hospital, Neo Faliro, 185 47 Athens, Greece.
Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 157 72 Athens, Greece.
Life (Basel). 2022 Jun 30;12(7):981. doi: 10.3390/life12070981.
The SuperPATH approach is a direct superior portal-assisted approach for total hip arthroplasty (THA) that utilizes the interval between the gluteus minimus and the piriformis to access the hip capsule. Patients and Methods: SuperPATH arthroplasty was performed by a single surgeon between December of 2016 and December of 2021 in 344 cases. The technique described by Chow was performed in all cases. The average length of stay was 1.3 days, and all patients were discharged for home. All patients were mobilized on the day of the operation. Six cases presented complications: four intraoperative femur fractures and two peroneal nerve palsies. No infection and no hip dislocation were noticed in any case. Modifications: We recommend that the patient be placed as far from the surgeon as possible as well as the use of a sterilized standard linen pack to elevate the foot and internally rotate the hip. In addition, regarding instrumentation, we recommend the use of a 4.5 mm drill for the first guidance femur drilling and a standard corkscrew for femoral head removal. Finally, we propose a different reduction technique using a hook. The use of the SuperPATH approach allows for maximal tissue sparing through preservation of external rotators and minimizing stretching of the gluteus medius. There is no range of motion restrictions postoperatively and patients can achieve a high level of function with a very low dislocation risk and reduced inpatient stay. Furthermore, an incision extension is possible if needed in complex cases. For surgeons familiar with the standard posterolateral approach, the SuperPATH approach is a reliable and safe method with promising results for the patient. In order to improve the surgical effect and facilitate some steps in the procedure, we share our experience and recommend some modifications.
SuperPATH入路是一种用于全髋关节置换术（THA）的直接上位门户辅助入路，它利用臀小肌和梨状肌之间的间隙进入髋关节囊。患者与方法：2016年12月至2021年12月期间，由一名外科医生对344例患者实施了SuperPATH关节成形术。所有病例均采用Chow描述的技术。平均住院时间为1.3天，所有患者均出院回家。所有患者均在手术当天即可活动。出现6例并发症：4例术中股骨骨折和2例腓总神经麻痹。未发现任何感染和髋关节脱位病例。改进措施：我们建议将患者放置在离外科医生尽可能远的位置，并使用消毒标准布单包裹来抬高足部并使髋关节内旋。此外，在器械使用方面，我们建议在首次引导股骨钻孔时使用4.5毫米钻头，在股骨头切除时使用标准螺旋钻。最后，我们提出一种使用钩子的不同复位技术。SuperPATH入路的使用通过保留外旋肌并最小化臀中肌的拉伸，实现了最大程度的组织保留。术后没有活动范围限制，患者能够实现高水平功能，脱位风险极低且住院时间缩短。此外，在复杂病例中如有需要可延长切口。对于熟悉标准后外侧入路的外科医生而言，SuperPATH入路是一种可靠且安全的方法，对患者有良好的效果。为了提高手术效果并简化手术过程中的一些步骤，我们分享我们的经验并推荐一些改进措施。
