Total Hip Arthroplasty: Contemporary Surgical Approaches, Navigation Technology and Determinant Factors of Clinical Outcomes. A Narrative Review
DOI:
https://doi.org/10.56294/ri2025207Keywords:
Total hip arthroplasty, SuperPATH, direct anterior approach, surgical navigation, institutional volume, minimally invasive surgeryAbstract
Background and Objective: Total hip arthroplasty (THA) represents one of the most successful orthopedic interventions for treating degenerative and traumatic hip pathologies. This narrative review aims to critically analyze current evidence regarding contemporary surgical approaches in THA, the role of computer-assisted technology, and determinant factors influencing clinical outcomes.
Methods: A comprehensive narrative literature review was conducted covering publications from 2010 to 2025 across PubMed, Scopus, SciELO, SpringerLink, and Google Scholar databases. Inclusion criteria comprised studies with sample sizes ≥30 patients, functional assessment using validated scales (Harris Hip Score, WOMAC, SF-36), and minimum three-month follow-up. Original articles, systematic reviews, meta-analyses, randomized controlled trials, and academic theses in English or Spanish were included.
Results: Minimally invasive approaches including SuperPATH (Supercapsular Percutaneous Assisted Total Hip) and direct anterior approach (DAA) demonstrate significant advantages over traditional posterior approach, including reduced intraoperative bleeding, decreased postoperative pain, and accelerated functional recovery. Meta-analyses involving over 1,500 patients confirm SuperPATH superiority in terms of blood loss reduction, shorter hospital stays, and lower dislocation rates. Intraoperative navigation technology improves acetabular component positioning accuracy, with up to 98% of implants placed within optimal anteversion and abduction ranges (15°-25° anteversion, 40°-45° abduction). Institutional surgical volume emerges as a critical determinant factor, with high-volume centers (>100 annual procedures) reporting significantly lower complication rates, reduced mortality, and improved functional outcomes.
Conclusions: Contemporary THA has evolved toward less invasive techniques with enhanced technological integration. The combination of minimally invasive surgical approaches, computer-assisted navigation, and centralization in high-experience centers represents the current trend for optimizing clinical and functional outcomes. Future directions include greater integration of robotic technology, advanced navigation systems, and personalized treatment approaches based on detailed preoperative analysis and three-dimensional modeling.
References
1. Zhao X, Yan S, Wang J, Liu Y. Direct and indirect comparisons in network meta analysis of SuperPATH, direct anterior and posterior approaches in total hip arthroplasty. BMC Musculoskelet Disord. 2023;24(1):123. https://pubmed.ncbi.nlm.nih.gov/36202828/.
2. Peng HM, Chen Q, Zhang Y, Li Z, Gao W. Comparison of anterior versus posterior approaches in total hip arthroplasty: a systematic review and meta analysis. BMC Musculoskelet Disord. 2020;21(1):78. https://pubmed.ncbi.nlm.nih.gov/32487060/.
3. Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002;(405):46-53. https://pubmed.ncbi.nlm.nih.gov/12461355/.
4. Wang Y, Guo L, Zhang W, Fan Y. Meta analysis of SuperPATH versus posterior approach in total hip arthroplasty: clinical outcomes and complications. BMC Musculoskelet Disord. 2023;24(1):95. https://doi.org/10.1186/s12891-023-07126-x
5. Wang F, Zhang X, Li J, Chen L, Shen H. Accuracy of acetabular component alignment with surgical navigation systems in total hip arthroplasty: a systematic review. SICOT J. 2023; 9:10. DOI: https://doi.org/10.1051/sicotj/2023009.
6. Smith TO, Hing CB. The influence of hospital volume on outcomes following total hip arthroplasty: a systematic review. J Orthop Surg Res. 2019;14(1):16. https://pubmed.ncbi.nlm.nih.gov/30646912/.
7. Prokopetz JJ, Losina E, Bliss RL, Wright J, Baron JA, Katz JN. Risk factors for revision of primary total hip arthroplasty: a systematic review. BMC Musculoskelet Disord. 2012; 13:251. https://pubmed.ncbi.nlm.nih.gov/23241362/.
8. Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am. 2015;97(17):1386-1397. https://pubmed.ncbi.nlm.nih.gov/26333733/.
9. Chen Z, Liu S, Huang Y, Hu J. A review of the direct anterior approach in total hip arthroplasty: indications, techniques, outcomes, and complications. Orthop Surg. 2023;15(1):8-15. https://pubmed.ncbi.nlm.nih.gov/36469017/.
10. Haughom BD, Gee AO, Smolenski RT. Complications in total hip arthroplasty: diagnosis and management. J Bone Joint Surg Am. 2020;102(4):370-381 https://pubmed.ncbi.nlm.nih.gov/32032194/.
11. Li X, Wang C, Ma B, Liu Y, Xu H. Minimally invasive SuperPATH approach in total hip arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2024;103(5): e3125. https://pmc.ncbi.nlm.nih.gov/articles/PMC10849345/.
12. Hernandez CJ, Sandoval-García F, Ahmed A, Pizones J. Learning curve and clinical outcomes of the direct anterior approach for total hip arthroplasty: a systematic review. J Orthop Surg. 2022;30(1):23094990221081330. https://pubmed.ncbi.nlm.nih.gov/35238246/.
13. Zhao L, Liu M, Zhang J, Yang H. Comparison of recovery outcomes between SuperPATH and direct anterior approaches for total hip arthroplasty: a meta analysis. Orthop Surg. 2023;15(4):1157-1166. https://pubmed.ncbi.nlm.nih.gov/36797841/.
14. Patel NK, Buller LT, Klika AK, Barsoum WK. Navigation and robotics in total hip arthroplasty: current concepts. Orthop Clin North Am. 2020;51(2):173-184. https://pubmed.ncbi.nlm.nih.gov/32138880/
15. Domb BG, El Bitar YF, Sadik AY, Stake CE, Perets I. Computer-assisted navigation and robotic technology in hip arthroscopy and total hip arthroplasty: an update. Orthop Clin North Am. 2021;52(3):333-342. https://pubmed.ncbi.nlm.nih.gov/34148610/
16. Kim YH, Kim JS, Park JW. Does surgeon volume affect outcomes following primary total hip arthroplasty? A systematic review. J Arthroplasty. 2018;33(3):962-967. https://pubmed.ncbi.nlm.nih.gov/29110983/
17. Hernandez NM, Barnes CL, Ong KL, Lau EC, Singh JA. Hospital and surgeon volume and outcomes after primary total hip arthroplasty: a systematic review. J Arthroplasty. 2018;33(9):2836-2843. https://pubmed.ncbi.nlm.nih.gov/29773418/
18. Bosco JA 3rd, Cross MB, Keggi JM. Effects of hospital volume on total hip arthroplasty outcomes. J Am Acad Orthop Surg. 2021;29(13): e633-e642. https://pubmed.ncbi.nlm.nih.gov/33835049/
19. Harris IA, Dao AT, Naylor JM. Centralization of total joint arthroplasty: impact on outcomes and costs. J Bone Joint Surg Am. 2022;104(9):793-799. https://pubmed.ncbi.nlm.nih.gov/35290285/
20. Khan SK, Malviya A, Muller SD, Patterson BM, Reed MR. Reduction in mortality and morbidity in hip replacement surgery with a fast-track protocol. Acta Orthop. 2014;85(1):26-31. https://pubmed.ncbi.nlm.nih.gov/24359028/
21. Bessette MC, Moussallem CD, Abdel MP, Mortazavi SMJ. Outcomes of total hip arthroplasty in patients with autoimmune rheumatic diseases: a systematic review. Semin Arthritis Rheum. 2021;51(2):334-342. https://pubmed.ncbi.nlm.nih.gov/33588251/
22. Goodman SM, Figgie M. Lower extremity arthroplasty in patients with inflammatory arthritis: preoperative and perioperative management. J Am Acad Orthop Surg. 2015;23(1):38-47. https://pubmed.ncbi.nlm.nih.gov/25538129/
23. Kehlet H. Fast-track hip and knee arthroplasty. Lancet. 2013;381(9878):1600-1602. https://pubmed.ncbi.nlm.nih.gov/23663938/
24. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop. 2008;79(2):168-173. https://pubmed.ncbi.nlm.nih.gov/18484241/
25. Ramadanov NN, Aliev RK, Ibrahimov DK. SuperPATH versus traditional hip replacement: updated meta-analysis. BMC Musculoskelet Disord. 2025;26(1):84. https://doi.org/10.1186/s12891-025-08471-9
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Copyright (c) 2025 Cevallos Navia Lincon Joan, Chávez Ruiz María Lisbeth, Quijije Sornoza Ingrid Paola, Franklin Antonio Vite Solorzano, Ruth Monserrate Delgado (Author)
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