Interest in the direct anterior approach for total hip arthroplasty has increased over recent years; however, the potential for substantial complications exists, especially during the surgeon’s learning curve. We evaluated the change in various metrics to help identify a single surgeon’s learning curve. Additionally, we examined whether the learning curve was different for primarily arthroplasty versus trauma-trained surgeons.
We reported outcomes from the first 50 total hip arthroplasties performed through a direct anterior approach by a trauma fellowship-trained orthopaedic surgeon. Intraoperative and post-operative clinical outcomes were evaluated, including length of procedure, estimated blood loss, length of hospitalization, disposition to home versus care facility, need for blood transfusion, and complications. Previous reported learning curve outcomes were analysed with a comparison between those who are primarily arthroplasty specialists versus those who include hip arthroplasty as only a portion of their practice.
A significant difference in surgical time from 135 to 113 min was observed between the first 25 cases and the last 25. Estimated blood loss (EBL) and lateral femoral cutaneous nerve injury rates decreased but not to a significant degree. Among reported learning curves, surgical time was significantly lower among fellowship-trained arthroplasty specialists when compared with other surgeons.
Our data support that surgeons who perform primarily joint arthroplasty will likely have a decreased surgical time, but similar EBL compared to those who include arthroplasty as only a portion of their practice, however, a number of confounding variables do exist, and additional investigation is warranted.
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Berend K, Lombardi AJ, Seng B, Al E (2009) Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. J Bone Jt Surg Am 91:107–120
Paillard P (2007) Hip replacement by a minimal anterior approach. Int Orthop 31:13–15
Repantis T, Bouras T, Korovessis P (2015) Comparison of minimally invasive approach versus conventional anterolateral approach for total hip arthroplasty: a randomized controlled trial. Eur J Orthop Surg Traumatol Orthop Traumatol 25:111–116. doi:10.1007/s00590-014-1428-x
York P, Smarck C, Judet T (2016) Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery. Int Orthop. doi:10.1007/s00264-016-3125-3
Pala E, Trono M, Bitonti A, Lucidi G (2016) Hip hemiarthroplasty for femur neck fractures: minimally invasive direct anterior approach versus postero-lateral approach. Eur J Orthop Surg Traumatol 26:423–427. doi:10.1007/s00590-016-1767-x
Homma Y, Baba T, Kobayashi H et al (2016) Benefit and risk in short term after total hip arthroplasty by direct anterior approach combined with dual mobility cup. Eur J Orthop Surg Traumatol 26:619–624. doi:10.1007/s00590-016-1808-5
Jewett B, Collis D (2007) High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res 469:503–507
Pilot P, Kerens B, Draijer W, Al E (2006) Is minimally invasive surgery less invasive in total hip replacement? A pilot study. Injury 37S:S17–S23
Homma Y, Baba T, Ochi H et al (2016) Greater trochanter chip fractures in the direct anterior approach for total hip arthroplasty. Eur J Orthop Surg Traumatol 26:605–611. doi:10.1007/s00590-016-1798-3
Alecci V, Valente M, Crucil M, Al E (2011) Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 12:123–129
De Geest T, Vansintjan P, De Loore G (2013) Direct anterior total hip arthroplasty: complications and early outcome in a series of 300 cases. Acta Orthop 79:166–173
Post Z, Orozco F, Diaz-Ledezma C, Al E (2014) Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg 22:595–603
Spaans A, van den Hout J, Bolder S (2012) High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 83:342–346
Woolson S, Pouliot M, Huddleston J (2009) Primary total hip arthroplasty using an anterior approach and a fracture table: short-term results from a community hospital. J Arthroplast 24:999–1005
American Academy of Orthopaedic Surgeons (2004) Orthopaedic practice in the US. 2005–2006. Final report
Seng B, Berend K, Ajluni A, Al E (2009) Anterior-supine minimally invasive total hip arthroplasty: defining the learning curve. Orthop Clin North Am 40:343–350
De Geest T, Fennema P, Lenaerts G, Al E (2015) Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis. Arch Orthop Trauma Surg 135:1183–1192. doi:10.1007/s00402-015-2258-y
Alexandrov T, Ahlmann E, Menendez L (2014) Early clinical and radiographic results of minimally invasive anterior approach hip arthroplasty. Adv Orthop. doi:10.1155/2014/954208
Yi C, Agudelo J, Dayton M, Al E (2013) Early complications of anterior supine intermuscular total hip arthroplasty. Orthopedics 36:e276–e281
Bhargava T, Goytia R, Jones L, Al E (2010) Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty. Orthopedics 33:472
D’Arrigo C, Speranza A, Monaco E, Al E (2009) Learning curve in tissue sparing total hip replacement: comparison between different approaches. J Orthop Trauma 10:47–54
Oinuma K, Eingartner C, Saito Y, Al E (2007) Total hip arthroplasty by a minimally invasive, direct anterior approach. Oper Orthop Traumatol 19:310–326
Zawadsky M, Paulus M, Murray P, Al E (2013) Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplast 29:1256–1260
Conflict of interest
The authors declare that they have no conflict of interest in relation to this manuscript.
IRB ethical approval was obtained prior to the start of this study.
There was no funding received for this study.
Informed consent was obtained from all individual participants included in the study.
Authorship statement: Each author confirms that he or she was involved in the development, writing, and editing of this manuscript. Each has had the opportunity to review the final version of the submitted work.
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York, P.J., Logterman, S.L., Hak, D.J. et al. Orthopaedic trauma surgeons and direct anterior total hip arthroplasty: evaluation of learning curve at a level I academic institution. Eur J Orthop Surg Traumatol 27, 421–424 (2017). https://doi.org/10.1007/s00590-017-1937-5
- Direct anterior approach
- Learning curve
- Total hip arthroplasty