Transitioning from the Posterior Approach to the Direct Anterior Approach for Total Hip Arthroplasty
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Total hip arthroplasty (THA) using the direct anterior approach (DAA) is known to have a learning curve. The purpose of this study was to review cases where surgery was performed by an arthroplasty surgeon transitioning from the posterior approach (PA) to the DAA. We hypothesized similar complication rates and improvements in surgical duration over time. Materials and Methods: A review of 2,452 consecutive primary THAs was conducted. Surgical duration, length of stay (LOS), surgical complications, decrease in postoperative day (POD) 1 hemoglobin, transfusion rates, POD 0 and POD 1 pain scores, incision length, leg length discrepancy (LLD), and radiographic cup position were recorded. Results: No differences in surgical duration were observed after the first 50 DAA cases. A shorter LOS was observed for the DAA, and statistical difference was appreciated after the first 100 DAA cases. There were no differences in periprosthetic fractures. A higher rate of infections and hip dislocations were observed with the PA. The PA showed an association with higher transfusion rates without significant difference in POD 1 decrease in hemoglobin over the first 100 DAA cases. Similar POD 0 and POD 1 pain scores with a smaller incision were observed for the first 100 DAA cases. The DAA cohort showed less variation in cup inclination, version, and LLD. Conclusion: DAA is safe and non-inferior in terms of reduced LOS, smaller incision, and less variation in cup position. Fifty DAA cases was noted to be the learning curve required before no differences in duration between approaches were observed.
Abstract
Purpose: Total hip arthroplasty (THA) using the direct anterior approach (DAA) is known to have a learning curve. The purpose of this study was to review cases where surgery was performed by an arthroplasty surgeon transitioning from the posterior approach (PA) to the DAA. We hypothesized similar complication rates and improvements in surgical duration over time. Materials and Methods: A review of 2,452 consecutive primary THAs was conducted. Surgical duration, length of stay (LOS), surgical complications, decrease in postoperative day (POD) 1 hemoglobin, transfusion rates, POD 0 and POD 1 pain scores, incision length, leg length discrepancy (LLD), and radiographic cup position were recorded. Results: No differences in surgical duration were observed after the first 50 DAA cases. A shorter LOS was observed for the DAA, and statistical difference was appreciated after the first 100 DAA cases. There were no differences in periprosthetic fractures. A higher rate of infections and hip dislocations were observed with the PA. The PA showed an association with higher transfusion rates without significant difference in POD 1 decrease in hemoglobin over the first 100 DAA cases. Similar POD 0 and POD 1 pain scores with a smaller incision were observed for the first 100 DAA cases. The DAA cohort showed less variation in cup inclination, version, and LLD. Conclusion: DAA is safe and non-inferior in terms of reduced LOS, smaller incision, and less variation in cup position. Fifty DAA cases was noted to be the learning curve required before no differences in duration between approaches were observed.
참고문헌 (17)
- Pincus D, "Association between surgical approach and major surgical complications in patients undergoing total hip arthroplasty", JAMA, 323, pp.1070~1076 (2020)[DOI]
- Seng BE, "Anteriorsupine minimally invasive total hip arthroplasty : defining the learning curve", Orthop Clin North Am, 40, pp.343~350 (2009)[DOI]
- Meermans G, "The direct anterior approach in total hip arthroplasty : a systematic review of the literature", Bone Joint J, 99-B, pp.732~740 (2017)[DOI]
- Free MD, "Direct anterior approach total hip arthroplasty : an adjunct to an enhanced recovery pathway : outcomes and learning curve effects in surgeons transitioning from other surgical approaches", J Arthroplasty, 33, pp.3490~3495 (2018)[DOI]
- Slotkin EM, "Accuracy of fluoroscopic guided acetabular component positioning during direct anterior total hip arthroplasty", J Arthroplasty, 30(9 Suppl), pp.102~106 (2015)[DOI]
- Sheth D, "Anterior and anterolateral approaches for THA are associated with lower dislocation risk without higher revision risk", Clin Orthop Relat Res, 473, pp.3401~3408 (2015)[DOI]
- Martin CT, "A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty", J Arthroplasty, 28, pp.849~854 (2013)[DOI]
- de Steiger RN, "What is the learning curve for the anterior approach for total hip arthroplasty?", Clin Orthop Relat Res, 473, pp.3860~3866 (2015)[DOI]
- Wang Z, "A systematic review and metaanalysis of direct anterior approach versus posterior approach in total hip arthroplasty", J Orthop Surg Res, 13, pp.229~ (2018)[DOI]
- Ponzio DY, "In-hospital morbidity and postoperative revisions after direct anterior vs posterior total hip arthroplasty", J Arthroplasty, 33, pp.1421~1425 (2018)[DOI]
- Haien Z, "Post-operative auto-transfusion in total hip or knee arthroplasty : a metaanalysis of randomized controlled trials", PLoS One, 8, pp.e55073~ (2013)[DOI]
- Horstmann WG, "Postoperative autologous blood transfusion drain or no drain in primary total hip arthroplasty? A randomised controlled trial", Int Orthop, 36, pp.2033~2039 (2012)[DOI]
- Upadhyay A, "Medical malpractice in hip and knee arthroplasty", J Arthroplasty, 22(6 Suppl 2), pp.2~7 (2007)[DOI]
- Desai AS, "Leg length discrepancy after total hip arthroplasty : a review of literature", Curr Rev Musculoskelet Med, 6, pp.336~341 (2013)[DOI]
- Cantrell WA, "Operative times have remained stable for total hip arthroplasty for >15 years : systematic review of 630, 675 procedures", JB JS Open Access, 4, pp.e0047~ (2019)[DOI]
- Hallert O, "The direct anterior approach : initial experience of a minimally invasive technique for total hip arthroplasty", J Orthop Surg Res, 7, pp.17~ (2012)[DOI]
- Hartford JM, "Perioperative complications stratified by body mass index for the direct anterior approach to total hip arthroplasty", J Arthroplasty, 35, pp.2652~2657 (2020)[DOI]