The Supercapsular Percutaneously Assisted Total Hip (SuperPATH) Approach Revisited: Technique Improvements after the Perioperative Experience of 344 Cases
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 o...
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MDPI AG
2022-06-01
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| Series: | Life |
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| Online Access: | https://www.mdpi.com/2075-1729/12/7/981 |
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| author | Dimitrios A. Flevas Georgios A. Tsakotos Leonardos N. Benakis Grigorios G. Sasalos Anastasios V. Tokis |
| author_facet | Dimitrios A. Flevas Georgios A. Tsakotos Leonardos N. Benakis Grigorios G. Sasalos Anastasios V. Tokis |
| author_sort | Dimitrios A. Flevas |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-09T03:17:21Z |
| format | Article |
| id | doaj.art-d8fc07ef9b1a4b018be3cc58fc52d174 |
| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-09T03:17:21Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj.art-d8fc07ef9b1a4b018be3cc58fc52d1742023-12-03T15:18:25ZengMDPI AGLife2075-17292022-06-0112798110.3390/life12070981The Supercapsular Percutaneously Assisted Total Hip (SuperPATH) Approach Revisited: Technique Improvements after the Perioperative Experience of 344 CasesDimitrios A. Flevas0Georgios A. Tsakotos1Leonardos N. Benakis2Grigorios G. Sasalos3Anastasios V. Tokis4Arthroscopy and Orthopaedic Surgery Department, Metropolitan Hospital, Neo Faliro, 185 47 Athens, GreeceArthroscopy and Orthopaedic Surgery Department, Metropolitan Hospital, Neo Faliro, 185 47 Athens, GreeceArthroscopy and Orthopaedic Surgery Department, Metropolitan Hospital, Neo Faliro, 185 47 Athens, GreeceArthroscopy and Orthopaedic Surgery Department, Metropolitan Hospital, Neo Faliro, 185 47 Athens, GreeceArthroscopy and Orthopaedic Surgery Department, Metropolitan Hospital, Neo Faliro, 185 47 Athens, GreeceThe 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.https://www.mdpi.com/2075-1729/12/7/981SuperPATH approachhip replacementhip reconstructionminimal invasive hiphip arthroplasty |
| spellingShingle | Dimitrios A. Flevas Georgios A. Tsakotos Leonardos N. Benakis Grigorios G. Sasalos Anastasios V. Tokis The Supercapsular Percutaneously Assisted Total Hip (SuperPATH) Approach Revisited: Technique Improvements after the Perioperative Experience of 344 Cases Life SuperPATH approach hip replacement hip reconstruction minimal invasive hip hip arthroplasty |
| title | The Supercapsular Percutaneously Assisted Total Hip (SuperPATH) Approach Revisited: Technique Improvements after the Perioperative Experience of 344 Cases |
| title_full | The Supercapsular Percutaneously Assisted Total Hip (SuperPATH) Approach Revisited: Technique Improvements after the Perioperative Experience of 344 Cases |
| title_fullStr | The Supercapsular Percutaneously Assisted Total Hip (SuperPATH) Approach Revisited: Technique Improvements after the Perioperative Experience of 344 Cases |
| title_full_unstemmed | The Supercapsular Percutaneously Assisted Total Hip (SuperPATH) Approach Revisited: Technique Improvements after the Perioperative Experience of 344 Cases |
| title_short | The Supercapsular Percutaneously Assisted Total Hip (SuperPATH) Approach Revisited: Technique Improvements after the Perioperative Experience of 344 Cases |
| title_sort | supercapsular percutaneously assisted total hip superpath approach revisited technique improvements after the perioperative experience of 344 cases |
| topic | SuperPATH approach hip replacement hip reconstruction minimal invasive hip hip arthroplasty |
| url | https://www.mdpi.com/2075-1729/12/7/981 |
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