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Selective THA-approach use amongst junior surgeons improves safety of introducing the anterior approach: a prospective, multi-surgeon, comparative, study

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Learning curves associated with independent practice and anterior approach total hip arthroplasty (AA-THA) has been associated with inferior outcome. This study compared outcome of junior, fellowship-trained, surgeons who perform THA through both anterior and posterior (PA) approach, with senior surgeons who perform either AA or PA, to determine whether: 1. Fellowship training and selective practice allows for safe introduction of AA into practice; and 2. Whether selective approach-use influences outcome.

Methods

This is a prospective, consecutive study comparing the first 800 THAs of two junior, dual-approach, surgeons (AA/PA: 455/345), with 400 THAs cases of two senior, single-approach, surgeons (AA/PA: 200/200), between 2018 and 2020. Most patients were female (54.4%), mean age was 65 years-old (range 19–96) and mean BMI was 29 kg/m2 (range 16–66). Outcome included radiologic measurements (inclination/anteversion and leg-length), complication- and revision rates, and patient-reported outcomes including Oxford Hip Score (OHS).

Results

At 3.1 years (range 2.0–6.8) follow-up, there were 43 complications (3.6%), including 27 re-operations (2.3%); with no difference between junior and senior surgeons for AA-THA (Junior: 8/455 vs. Senior: 3/200; p = 0.355) or PA-THA (Junior: 11/345 vs. Senior: 5/200; p = 0.400). Amongst juniors, there was no difference in complications (AA:8/455 vs. PA:11/345; p = 0.140) and in ΔOHS (AA:20.5 ± 7.7 vs. PA:20.5 ± 8.0; p = 0.581) between approaches.

Conclusion

Contemporary training and selective approach-use minimizes the learning curve, allowing junior staff to have equivalent outcome to established, senior surgeons in both AA and PA. We would advocate for selective approach use amongst junior arthroplasty surgeons when introducing the AA into independent practice.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing, Suite CCW 1638, Ottawa, ON, K1H 8L6, Canada

    Jeroen C. F. Verhaegen, Reza Ojaghi, Paul Kim & George Grammatopoulos

  2. University Hospital Antwerp, Edegem, Belgium

    Jeroen C. F. Verhaegen

  3. Orthopaedic Centre Antwerp, Antwerp, Belgium

    Jeroen C. F. Verhaegen

  4. Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA

    Adam J. Schwarz & Josh Bingham

Authors
  1. Jeroen C. F. Verhaegen
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  2. Reza Ojaghi
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  3. Paul Kim
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  6. George Grammatopoulos
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Correspondence to George Grammatopoulos.

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Verhaegen, J.C.F., Ojaghi, R., Kim, P. et al. Selective THA-approach use amongst junior surgeons improves safety of introducing the anterior approach: a prospective, multi-surgeon, comparative, study. Arch Orthop Trauma Surg 143, 6829–6836 (2023). https://doi.org/10.1007/s00402-023-04895-x

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