Patient-related Predictors for the Functional Outcome of SuperPATH Hemiarthroplasty versus Conventional Approach Hemiarthroplasty: A Systematic Review and Meta-regression Analysis of Randomized Controlled Trials

Abstract

Specialist literature lacks evidence that explores associations between patient characteristics and the beneficial treatment effect of SuperPATH hemiarthroplasty (HA) compared with conventional approach (CA) HA. To investigate and identify patient-related predictors of the effect size of the short-term functional outcome of SuperPATH HA and CA HA by performing a systematic review and meta-regression analysis of randomized controlled trials (RCTs). A systematic search of literature was performed in PubMed, CNKI, CENTRAL of The Cochrane Library, Clinical trials, and Google Scholar until August 25, 2023. For the continuous outcome parameter Harris hip score (HHS) ≤1 week and 3 months postoperatively, mean differences (MDs) with 95% confidence intervals (CIs) were calculated. A meta-regression analysis was based on random-effects meta-analysis using the Hartung–Knapp–Sidik–Jonkman method for continuous covariates. A total of five RCTs with 404 patients were found. The following predictors of HHS ≤1 week postoperatively were identified: patient age (predictor estimate = 1.29; p < 0.01), patient age groups (predictor estimate = 14.07; p < 0.01), time to mobilization (predictor estimate = 5.51; p < 0.01). The following predictors of HHS 3 months postoperatively were identified: incision length (predictor estimate = −2.12; p < 0.01); intraoperative blood loss (predictor estimate = 0.02; p < 0.01). Patient age, time to mobilization, incision length, and intraoperative blood loss were identified as predictors of the effect size of early postoperative functional outcome as measured by HHS. Elderly patients, particularly those over 70 years of age, appear to benefit from SuperPATH HA. Based on these findings, and taking into account our limitations, we recommend that the use of minimally invasive SuperPATH HA in elderly patients should be more widely considered and not limited to elective THA patients.

Keywords

conventional approaches / hemiarthroplasty / meta-analysis / meta-regression / SuperPATH

References

[1] RachbauerF, KainMS, LeunigM. The history of the anterior approach to the hip. Orthop Clin North Am. 2009;40(3):311–320.

[2] ChowJ, Penenberg B, MurphyS. Modified micro-superior percutaneously-assisted total hip: early experiences & case reports. Curr Rev Musculoskelet Med. 2011;4(3):146–150.

[3] RamadanovN. SuperPATH-current status of evidence and further investigations: a scoping review and quality assessment. J Clin Med. 2023;12(16):5395.

[4] Watson-JonesR. Fractures of the neck of the femur. Br J Surg. 1936;23:787–808.

[5] RamadanovN, Jóźwiak K, HauptmannM, LazaruP, Marinova-Kichikova P, DimitrovD, et al. Cannulated screws versus dynamic hip screw versus hemiarthroplasty versus total hip arthroplasty in patients with displaced and non-displaced femoral neck fractures: a systematic review and frequentist network meta-analysis of 5703 patients. J Orthop Surg Res. 2023;18(1):625.

[6] OñativiaIJ, Slullitel PA, Diaz DilerniaF, Gonzales ViezcasJM, Vietto V, RamkumarPN, et al. Outcomes of nondisplaced intracapsular femoral neck fractures with internal screw fixation in elderly patients: a systematic review. Hip Int. 2018;28(1):18–28.

[7] RamadanovN, TomaI, HerknerH, Klein R, BehringerW, MatthesG. Factors that influence the complications and outcomes of femoral neck fractures treated by cannulated screw fixation. Sci Rep. 2020;10(1):758.

[8] KunkelST, Sabatino MJ, KangR, JevsevarDS, Moschetti WE. A systematic review and meta-analysis of the direct anterior approach for hemiarthroplasty for femoral neck fracture. Eur J Orthop Surg Traumatol. 2018;28(2):217–232.

[9] KhanIA, Magnuson JA, ArshiA, KruegerCA, Freedman KB, FillinghamYA. Direct anterior approach in hip hemiarthroplasty for femoral neck fractures: do short-term outcomes differ with approach?: a systematic review and meta-analysis. JBJS Rev. 2022;10(9):e21.00202.

[10] FilippiniM, Bortoli M, MontanariA, PaceA, Di Prinzio L, LonardoG, et al. Does surgical approach influence complication rate of hip hemiarthroplasty for femoral neck fractures? A literature review and meta-analysis. Medicina (Kaunas). 2023;59(7):1220.

[11] ZhangJK, WuJL, ZhengXG, Zhu HM, PangQJ. Meta-analysis of direct anterior approach and other approaches for hemiarthroplasty in elderly patients with femoral neck fracture. Zhongguo Gu Shang. 2020;33(8):776–783. In Chinese.

[12] RamadanovN, Jóźwiak K, Marinova-KichikovaP, LazaruP, Dimitrov D. Hemiarthroplasty through SuperPATH versus hemiarthroplasty through conventional approaches in patients with femoral neck fractures: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2023;13(1):22861.

[13] RamadanovN, Ostojic M, LazaruP, LiuK, HableR, Marinova-KichikovaP, et al. Risk factors and predictors for functional outcome and complication rate in Total hip arthroplasty through minimally invasive and conventional approaches: a systematic review and meta-regression analysis of 41 randomized controlled trials. J Clin Med. 2023;12(18):5895.

[14] HarrisWH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.

[15] HigginsJPT, DeeksJ, AltmanD. Chapter 16: Special topics in statistics. In: Higgins JPT, GreenS, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. London, England: The Cochrane Collaboration; 2011.

[16] SterneJAC, Savović J, PageMJ, ElbersRG, Blencowe NS, BoutronI, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

[17] GuyattGH, OxmanAD, VistGE, Kunz R, Falck-YtterY, Alonso-CoelloP, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–926.

[18] LinL, ChuH. Quantifying publication bias in meta-analysis. Biometrics. 2018;74(3):785–794.

[19] NeupaneB, RicherD, BonnerAJ, Kibret T, BeyeneJ. Network meta-analysis using R: a review of currently available automated packages. PloS One. 2014;9(12):e115065.

[20] BerkeyCS, Hoaglin DC, Antczak-BouckomsA, MostellerF, Colditz GA. Meta-analysis of multiple outcomes by regression with random effects. Stat Med. 1998;17(22):2537–2550.

[21] DaiGH, YinY, JiYY, YiSQ. Effect of artificial femoral head replacement on senile osteoporotic femoral neck fracture. J Trauma Surg. 2019;21(10):761–765.

[22] JiaJ, YuB, WuL, ZhiZ, PanL. Hip hemiarthroplasty for senile femoral neck fractures: minimally invasive SuperPath approach versus traditional posterior approach. Chin J Geriatr Orthop Rehabil. 2017;3(4):223–231.

[23] WangX, TianJ. Minimally invasive femoral head replacement for elderly femoral neck fractures: study on the effect of postoperative hip joint range of motion. Guizhou Med J. 2021;45(5):780–782.

[24] XiaLZ, LiSH, YuanZS, Deng YH, ZhuDQ, YeWS, et al. Common bipolar femoral head by SuperPATH approach for senile femoral neck fractures. Chin J Tiss Eng Res. 2018;22(19):2953–2960.

[25] ZhaoL, LiQ, XuB. Treatment of hemiarthroplasty with SuperPATH minimally invasive approach: clinical curative effect analysis of femoral neck fracture in elderly patients. Contemp Med. 2019;25(34):144–146.

[26] ChangM, LiuX, FengY, Liu Z. Treatment of bipolar femoral head replacement with modified SuperPATH approach: early and mid-term curative effect analysis of femoral neck fracture in the elderly. Chin J Clin. 2022;50(4):465–468.

[27] DingB, BaoF, ChenX, Cai H, WangZ, GongJ, et al. Minimally invasive SuperPath approach versus conventional approach in elderly patients with femoral neck fracture. J J Traumatic. 2018;23(3):471–472.

[28] DingY. Minimally invasive SuperPath approach artificial femoral head replacement in the treatment of femoral neck fractures in the elderly. Shenzhen J Int Med. 2018;28(16):129–131.

[29] GongQ, GongW, ZhouG, Shui G, LuJ, HuangZ, et al. SuperPATH approach artificial femoral head replacement combined with traditional Chinese medicine in the treatment of elderly femoral neck. Pract Int Trad Chin West Med. 2018;18(8):36–38.

[30] GuS, WangJ, XuK, LiuH. Short-term effect of hip arthroplasty through the SuperPATH approach for femoral neck fractures. Chin J Bone Joint Surg. 2018;11(10):742–745.

[31] HuangJ, LuX, ChenC, Chen G, ChenX. Study on the rapid rehabilitation of elderly patients with femoral neck fracture after hip replacement via minimally invasive SuperPATH approach. Med Innov China. 2021;18(7):1–5.

[32] JiD, XiaL, JiangY, Wang K, DengY, ZhuD, et al. Conventional instrument SuperPATH approach versus the anterolateral approach for femoral head replacement: a randomized controlled comparison of efficacy. Chin J Tiss Eng Res. 2021;25(30):4833–4838.

[33] JianboJ, YingJ, XinxinL, Lianghao W, BaoqingY, RongguangA. Hip hemiarthroplasty for senile femoral neck fractures: minimally invasive SuperPath approach versus traditional posterior approach. Injury. 2019;50(8):1452–1459.

[34] LiY, HeZK, GuoXM, Sun X, YangY. Effects of artificial femoral head replacement between SuperPath approach and small incision posterolateral approach on elderly patients with femoral neck fractures. J Rare Unc Dis. 2019;26(5):66–75.

[35] LiM. VAS score and hip recovery in patients with femoral neck fractures treated with SuperPATH approach for hip arthroplasty. Pract Int Med. 2021;21(13):28–29.

[36] TianM, GaoY, WuW, ShuJ. SuperPATH approach for hip arthroplasty in the treatment of femoral neck fractures: effectiveness and effect on complication rate. Chin J Clin. 2020;48(1):82–84.

[37] WuGH, DiY, MaYH, ZhaoJL, LiangYH. Short-term efficacy of SuperPATH approach for hip arthroplasty in the elderly with femoral neck fracture. Chin J Mult Organ Dis Elderly. 2018;17(7):529–532.

[38] XuG, HuL, YangS. SuperPATH minimally invasive approach artificial femoral head replacement: a short-term follow-up study on the treatment of femoral neck fractures in the elderly. Hainan Med J. 2018;29(17):2400–2404.

[39] ZhaoS. Minimally invasive SuperPATH approach hip arthroplasty for aged legs: clinical curative effect analysis of patients with neck fracture. Mod Diagn Treat. 2021;32(22):3593–3594.

[40] NwachukwuBU, ChangB, RotterBZ, Kelly BT, RanawatAS, NawabiDH. Minimal clinically important difference and substantial clinical benefit after revision hip arthroscopy. Art Ther. 2018;34(6):1862–1868.

[41] FanCJ, ChienHL, WeissMJ, He J, WolfgangCL, CameronJL, et al. Minimally invasive versus open surgery in the Medicare population: a comparison of post-operative and economic outcomes. Surg Endosc. 2018;32(9):3874–3880.

[42] KuruT, Olçar HA. Effects of early mobilization and weight bearing on postoperative walking ability and pain in geriatric patients operated due to hip fracture: a retrospective analysis. Turk J Med Sci. 2020;50(1):117–125.

[43] MiglioriniF, Pintore A, EschweilerJ, OlivaF, Hildebrand F, MaffulliN. Factors influencing the outcomes of minimally invasive total hip arthroplasty: a systematic review. J Orthop Surg Res. 2022;17(1):281.

[44] McGonagleL, Convery-Chan L, DeCruzP, HaebichS, FickDP, KhanRJK. Factors influencing return to work after hip and knee arthroplasty. J Orthop Traumatol. 2019;20(1):9.

[45] TanakaR, Shigematsu M, MotookaT, MawatariM, Hotokebuchi T. Factors influencing the improvement of gait ability after total hip arthroplasty. J Arthroplasty. 2010;25(6):982–985.

[46] HernándezC, Díaz-Heredia J, BerraqueroML, CrespoP, LozaE, Ruiz IbánMÁ. Pre-operative predictive factors of post-operative pain in patients with hip or knee arthroplasty: a systematic review. Reumatol Clin. 2015;11(6):361–380.

RIGHTS & PERMISSIONS

2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.