An Updated Meta-Analysis of Randomized Controlled Trials on Total Hip Arthroplasty through SuperPATH versus Conventional Approaches

The object was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) up to the present to draw reliable conclusions in the comparison between short-term outcomes of total hip arthroplasty (THA) through supercapsular percutaneously assisted approach in THA (supercapsular percutaneously-assisted total hip (SuperPATH)) versus conventional approaches (CAs). A systematic literature search was performed to identify RCTs comparing primary and secondary outcomes of THA through SuperPATH vs. CAs. Mean differences (MDs) were calculated for continuous outcomes and odds ratios (ORs) for dichotomous outcomes, using the DerSimonian and Laird method, the Mantel-Haenszel method and random effects model. A total of 14 RCTs involving 1021 patients met the inclusion criteria. Primary outcomes: SuperPATH reduced intraoperative blood loss (MD = -61.4, 95% CI -119.1 to -3.8). SuperPATH increased Harris hip score (HHS) 3, 6 and 12 months postoperatively (MD = 2.4, 95% CI 0.6-4.2; MD = 2.1, 95% CI 0.6-3.6; MD = 0.7, 95% CI 0.1-1.3; resp.). Both approaches did not differ in postoperative complication rates (OR = 0.7, 95% CI 0.2-3.3). Secondary outcomes: SuperPATH reduced pain visual analogue scale (VAS) 1 day and 3 days postoperatively (MD = -1.0, 95% CI -1.8 to -0.2; MD = -1.2, 95% CI -1.8 to -0.5; resp.). SuperPATH reduced incision length (MD = -5.2, 95% CI -7.0 to -3.4). SuperPATH increased operation time (MD = 14.3, 95% CI 3.7-24.8). Both approaches did not differ relevantly in acetabular cup inclination (MD = -1.8, 95% CI -3.8-0.2) and acetabular cup anteversion (MD = -0.6, 95% CI -1.2 to -0.1) angles. The overall findings of this meta-analysis (Meta-SuCAs-2) suggested that the short-term outcomes of THA through SuperPATH were superior to CAs. In the primary outcome, SuperPATH had a lower intraoperative blood loss and a higher HHS. Both approaches did not differ in postoperative complications. In the secondary outcome, SuperPATH had a lower pain VAS and a shorter incision length. Both approaches showed sufficient results in acetabular cup positioning. CAs had a shorter operation time than SuperPATH.