Abstract
Tissue sparing hip replacements have recently gained popularity, in an attempt to provide shorter hospital stay, faster recovery time and potentially to reduce morbidity and complications. Direct anterior approaches (DAA) have been shown to allow faster recovery, but also appear to be associated with a higher incidence of complications, especially during the learning curve. Mini-posterior approaches have the advantage of increased familiarity, however may not be maximally muscle sparing.
Prospective and retrospective data was collected following a published protocol. This included patient demographic data, theatre time, units of blood transfused, length of stay, functional scores and radiological parameters. Rates of conversion to posterior approach and complications were also documented.
The results of our first 100 cases completed are presented: Within this initial cohort, three patients suffered major complications: These included an anterior dislocation, which was successfully reduced with closed reduction under general anaesthetic, an early (day 6) periprosthetic fracture, which was successfully revised to a cemented prosthesis, and a case of stem subsidence.
Our results also suggest a learning curve effect, limited to theatre time and blood loss. Complications were evenly distributed throughout the period of study and are of similar frequency to standard approaches.
As the first European centre to adopt the SuperPATH approach, we have shown that the published results from America can be reproduced. In contrast to DAA, the learning curve is not associated with higher rates of femoral fracture and other complications. The fact that the approach is extensile, being the superior part of the posterior approach, allows for all of the advantages of muscle preservation with the safety of potential extension when necessary.
