A prospective randomised comparison of earlier function after total hip arthroplasty with a mini posterior approach or supercapsular percutaneously-assisted total hip approach: a gait analysis study

Abstract

Background:

The supercapsular percutaneously-assisted total hip (SuperPATH) approach is a muscle sparing surgical technique for total hip arthroplasty (THA). The literature reports good clinical and functional results of the SuperPATH technique in the short term. We aimed to compare early outcomes and gait analysis of THA using the mini posterior approach (MPA) and supercapsular percutaneously-assisted total hip (SuperPATH) approach.

Methods:

44 patients who underwent THA, were randomly allocated to either MPA or SuperPATH. The data were then collected prospectively (preoperatively and postoperatively at 6 weeks). Plain anteroposterior radiographs of the pelvis and instrumental gait analysis were obtained. The visual analogue scale (VAS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Scores (HOOS) were used to assess functional and clinical outcomes.

Results:

No significant difference was found in patients’ surgical outcomes. Patients in the SuperPATH group had less pain according to the VAS score at follow-up than the MPA group (p < 0.01). There was also a significant improvement in HHS and HOOS scores for all patients (p < 0.001) with the SuperPATH group showing superior changes. The comparison of mean differences in gait velocity between preoperative and 6 weeks postoperative result, revealed improvement in the SuperPATH group over the MPA group (p = 0.06). Limping was more persistent in the MPA group. Kinematic parameters demonstrated improved hip joint excursion slightly higher in the MPA group. There was no significant improvement in kinetic and kinematic parameters at different walking moments for all patients at 6 weeks compared to preoperative gait patterns.

Conclusions:

SuperPATH and MPA both show excellent results. This study reveals that the SuperPATH technique was associated with lower postoperative pain levels, and higher physical function and quality of life. Improved functional outcomes allowed earlier postoperative rehabilitation and faster recovery. Specific improvement in gait patterns were identified with nonsignificant differences between the 2 approaches at 6 weeks follow-up.

Keywords

Gait analysis minimally invasive surgery mini posterior approach SuperPATH total hip arthroplasty

Get full access to this article

View all access options for this article.

References

Marker

Strimbu

McGrath

, et al. Resurfacing versus conventional total hip arthroplasty – review of comparative clinical and basic science studies. Bull NYU Hosp Jt Dis 2009; 67: 120–127.

Hammett

Simonian

Austin

, et al. Changes in physical activity after total hip or knee arthroplasty: a systematic review and meta-analysis of six- and twelve-month outcomes. Arthritis Care Res 2018; 70: 892–901.

Smith

Wylde

Berstock

, et al. Surgical approach and patient-reported outcomes after total hip replacement. Hip Int 2012; 22: 355–361.

Inaba

Dorr

Wan

, et al. Operative and patient care techniques for posterior mini-incision total hip arthroplasty. Clin Orthop Relat Res 2005; 441: 104–114.

Chow

Penenberg

Murphy

. Modified micro-superior percutaneously-assisted total hip: early experiences & case reports. Curr Rev Musculoskelet Med 2011; 4: 146–150.

Della Torre

Fitch

Chow

. Supercapsular percutaneously-assisted total hip arthroplasty: radiographic outcomes and surgical technique. Ann Transl Med 2015; 3: 180.

Rasuli

Gofton

. Percutaneously assisted total hip and supercapsular percutaneously assisted total hip arthroplasty: learning curves and early outcomes. Ann Transl Med 2015; 3: 179.

Madsen

Ritter

Morris

, et al. The effect of total hip arthroplasty surgical approach on gait. J Orthop Res 2004; 22: 44–50.

Petis

Howard

Lanting

, et al. Comparing the anterior, posterior and lateral approach: gait analysis in total hip arthroplasty. Can J Surg 2018; 61: 50–57.

10.

Pincheira

De La Maza

Silvestre

, et al. Comparison of total hip arthroplasty surgical approaches by Statistical Parametric Mapping. Clin Biomech 2019; 62: 7–14.

11.

Della Valle

Dittle

Moric

, et al. A prospective randomized trial of mini-incision posterior and two-incision total hip arthroplasty. Clin Orthop Relat Res 2010; 468: 3348–3354.

12.

Michael

Wade

Lindsey

, et al. Early surgical and functional outcomes comparison of the supercapsular percutaneously-assisted total hip and traditional posterior surgical techniques for total hip arthroplasty: protocol for a randomized, controlled study. Ann Transl Med 2015; 3: 335.

13.

Reikeras

Gunderson

. Cross table lateral radiography for measurement of acetabular cup version. Ann Transl Med 2016; 4: 169.

14.

Nilsdotter

Bremander

. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res (Hoboken) 2011; 63(Suppl. 11): S200–S207.

15.

Wohlrab

Hagel

Hein

. Advantages of minimal invasive total hip replacement in the early phase of rehabilitation. Z Orthop Ihre Grenzgeb 2004; 142: 685–690.

16.

Mayr

Nogler

Benedetti

, et al. A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Clin Biomech 2009; 24: 812–818.

17.

Kadaba

Ramakrishnan

Wootten

. Measurement of lower extremity kinematics during level walking. J Orthop Res 1990; 8: 383–392.

18.

Kiss

. Effect of walking speed and severity of hip osteoarthritis on gait variability. J Electromyogr Kinesiol 2010; 20: 1044–1051.

19.

Foucher

Schlink

Shakoor

, et al. Sagittal plane hip motion reversals during walking are associated with disease severity and poorer function in subjects with hip osteoarthritis. J Biomech 2012; 45: 1360–1365.

20.

Reinking

Ripple

Schleper

, et al. Reliability of two-dimensional video-based running gait analysis. Int J Sports Phys Ther 2018; 13: 453–461.

21.

Schurr

Marshall

Resch

, et al. Two-dimensional video analysis is comparable to 3D motion capture in lower extremity movement assessment. Int J Sports Phys Ther 2017; 12: 163–172.

22.

Colgan

Walsh

Bennett

, et al. Gait analysis and hip extensor function early post total hip replacement. J Orthop 2016; 13: 171–176.

23.

Eitzen

Fernandes

Nordsletten

, et al. Sagittal plane gait characteristics in hip osteoarthritis patients with mild to moderate symptoms compared to healthy controls: a cross-sectional study. BMC Musculoskelet Disord 2012; 13: 258.

24.

Xie

Zhang

Wang

, et al. Comparison of supercapsular percutaneously assisted approach total hip versus conventional posterior approach for total hip arthroplasty: a prospective, randomized controlled trial. J Orthop Surg Res 2017; 12: 138.

25.

Queen

Butler

Watters

, et al. The effect of total hip arthroplasty surgical approach on postoperative gait mechanics. J Arthroplasty 2011; 26(Suppl.): 66–71.

26.

Rathod

Orishimo

Kremenic

, et al. Similar improvement in gait parameters following direct anterior & posterior approach total hip arthroplasty. J Arthroplasty 2014; 29: 1261–1264.