Supercapsular percutaneously-assisted total hip (SuperPath) versus posterolateral total hip arthroplasty in bilateral osteonecrosis of the femoral head: a pilot clinical trial
Abstract Background: 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). Methods: Patients with bilateral late-stage ONFH were prospectively recruited from our department during 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 groups. 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 groups within 12-month postoperatively. Results: 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 significantly shorter incision length (7.62 vs. 11.12 cm, P = 0.049), longer operation time (103.25 vs. 66.50 min, P = 0.034), more blood loss (1108.50 vs. 843.50 ml, P = 0.023), deficient acetabular cup positioning (abduction angle, 38.75° vs. 44.50°, P = 0.035), and inferior early-term hip function (Harris hip score, 72.50 vs. 83.25, P = 0.025) at 12-month postoperatively. However, soft tissue damage, length of hospital stay, postoperative pain, postoperative range of motion, and 12-month patient satisfaction were comparable between both groups. Conclusions: The SuperPath might not be truly minimal invasive with advantages over the 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.