Short-term Results of SuperPATH Versus Direct Lateral Approach In Primary Total Hip Arthroplasty: A Randomized Controlled Study.

Total hip arthroplasty (THA) has shown great success in relieving joint pain and disability and has been a procedure of choice for the treatment of end-stage degenerative joint diseases and trauma. There are multiple surgical approaches for THA, including the traditional posterior approach, anterior approach, lateral approach, anterolateral approach and posterolateral approach; each has its advantages and complications. Modified direct lateral approach is considered as standard, most commonly used and familiar in Assiut university Arthroplasty centre. Yet it may cause abductor weakness, post operative pain, prolonged rehabilitation time and more blood loss. In the past two decades, the group of micro-posterior approaches was introduced. In 2004 Stephen Murphy developed the Supecapsular (SuperCap) approach, preparing the hip insitu to reduce soft tissue traumatization caused by the dislocation manoeuvre used in the conventional posterior approach. , In 2008 Brad Penenberg developed the percutaneously-assisted total hip (PATH) app, a tissue-sparing approach leading through the interval between gluteus medius and the conjoined tendon of the external rotators. In2011, James Chow described the supercapsular percutaneously-assisted total hip (SuperPATH) approach, the most Important features of SuperPATH are the following: (a) muscle sparing between gluteus medius and piriformis without detaching external rotator tendons or disrupting the hip capsule, (b) femur preparation first without dislocation (c) percutaneous acetabular preparation. SuperPATH approach is designed to reduce soft tissue trauma and so blood loss, post operative pain, improve joint stability and allow earlier mobilization of patients. Despite the theoretical advantages of the SuperPATH approach, its adoption remains limited compared with conventional surgical approaches. Furthermore, there is ongoing debate regarding its clinical superiority in terms of functional outcomes, complication rates and implant position. Aim of our study is to evaluate the clinical and functional outcomes of total hip arthroplasty performed using SuperPATH compared to modified direct lateral approach.

Inclusion Criteria: 1. Primary total hip arthroplasty. 2. Age \> 18 years. 3. Body mass index \< 40 kg/m2. 4. Able to ambulate preoperative. Exclusion Criteria: 1. Hip deformity (acetabular or femoral). 2. Ankylosed hips. 3. Severe osteoporosis. 4. Neuromuscular disorders.