Evaluation of the Learning Curve When Transitioning From Posterolateral to Direct Anterior Hip Arthroplasty: A Consecutive Series of 1000 Cases

Stone, Andrea H.; Sibia, Udai S.; Atkinson, R E; Turner, Timothy R.; King, Paul J.

doi:10.1016/j.arth.2018.02.086

Cited by 61 publications

(36 citation statements)

References 26 publications

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“…14,33,37,40,44,45,48 In comparison, intraoperative fluoroscopy was used in 96.9% (10,870/11,220) of patients in the 16 traction table studies that reported it. 5,7,9,11,[50][51][52][55][56][57][58][59][60][61][62][63] In 15 standard table studies reporting specific implants (n = 4130), there were 54 (1.3%) cemented femoral implants used 26,42 and 4076 (98.7%) cementless femoral implants used. 14,26,29,33,[36][37][38][39][40][41][42][43][44][45]48 In 11 traction table studies that reported specific implants (n = 7189), there were 76 (1.0%) cemented femoral implants 9,54,59 and 7351 (99.0%) cementless femoral implants used.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Revision rate was reported in four standard table studies 31,33,38,42 (n = 2546) and 11 traction table studies (n = 4536). 5,7,9,50,51,53,56,58,62,63 There were 57 revisions (2.2%) in the standard table studies, for unspecified reasons. In the traction table studies, there were 115 revisions (2.5%) with 7 specified to be due to infection, 2 for thigh pain, 1 for alumina-on-alumina squeaking and 1 due to loosening.…”

Section: Complicationsmentioning

confidence: 99%

“…There were 10 31,33,39-42,47 (n = 3156) standard table and 11 traction table studies 5,7,9,50,51,54,56,58,62,63 (n = 4070) reporting on postoperative dislocation, with a total rate of 0.5% for standard table (16 dislocations) and 0.5% (20 dislocations) for traction table.…”

Section: Complicationsmentioning

confidence: 99%

“…14 7 traction table studies (n = 3501) reported periprosthetic fractures at a rate of 0.5% (19 unspecified femoral fractures). 7,9,50,51,56,62,63 Complication rates are summarised in Table 5 and presented in Figure 3.…”

Section: Complicationsmentioning

confidence: 99%

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Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

et al. 2020

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Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) was originally performed with a supine patient on a specialised traction table, but the approach can also be performed on a standard operating table. Despite cost and safety implications, there are few studies directly comparing these techniques and table choice remains largely surgeon preference. The purpose of this review was to compare the clinical outcomes and complication profiles of traction and standard table DAA for primary THA. Methods: The authors searched databases for relevant studies, screening in duplicate. Study quality was assessed using MINORS criteria or Cochrane Risk of Bias Tool. Data pertaining to patient demographics, clinical outcomes, and complications were abstracted. Results: Of 3085 initial titles, 44 studies containing a total 26,353 patients were included and analysed. Mean operative time was 70.9 ± 21.2 minutes for standard table ( n = 4402) and 100.1 ± 32.6 minutes for traction table ( n = 3518). Mean estimated blood loss was 382.3 ± 246.4 mL for standard ( n = 2992) and 531.7 ± 364.3 mL for traction table ( n = 2675). Intra-operative fracture rate was 1.3% for standard table ( n = 3940) and 1.7% for traction table ( n = 8386). Complication rates including revisions, dislocations and peri-prosthetic fractures were qualitatively similar between traction and standard table studies. Conclusion: Standard table and traction table DAA have similar outcomes and complications. Both techniques offer the short-term advantages of DAA when compared to other THA approaches. However, the standard table technique may offer perioperative advantages including decreased blood loss, shorter operative time, and fewer intraoperative fractures. In the context of rising global healthcare costs and lack of access to specialised orthopaedic traction tables, this review at minimum confirms the short-term safety of standard table DAA THA and prompts the need for future studies to directly compare these techniques.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

et al. 2020

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“…In terms of operative time, blood loss and complication rates, multiple studies have reported the learning curve for DAA THAs ranges from 10 to 200 cases 14) . In a study by Stone et al 15) in a consecutive series of 1,000 cases when transitioning from PA to DAA THA, the mean operative time increased by about 30% in the initial 50 cases, and decreased by 14% in the second 50 cases. They reported that operative time of DAA THA was shorter compared with posterior hip arthroplasty after the 500th cases.…”

Section: Discussionmentioning

confidence: 96%

Early Experience of Direct Anterior Approach Total Hip Arthroplasty: Analysis of the First 53 Cases

et al. 2020

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Purpose: To determine if it is feasible and safe for a surgeon to transition from using the posterolateral approach to direct anterior approach (DAA) by evaluating the first 53 cases of total hip arthroplasty using a DAA. Materials and Methods: A retrospective review of 52 patients who underwent THA using a DAA between July 2017 and December 2018. Reasons for THA were: femoral neck fracture (n=34), avascular necrosis (n=13), and arthritis (n=6). The mean age was 70 years old. An assessment of feasibility was made by analyzing mean operative time and blood loss. Cup inclination, anteversion, and leg length discrepancy (LLD) were measured using postoperative radiology. Safety of the DAA was judged using the incidence and nature of all complications. Results: The mean operative time was 112 minutes. 135 minutes for the 1st 10 cases, 100 minutes for 2nd 10 cases, 113 minutes for 3rd 10 cases, 119 minutes for 4th 10 cases, and 91 minutes for the final 13 cases. The mean blood loss was 724 mL. Average cup inclination was 40.27。 ; 2 cases were out of safety angle. Mean anteversion was 16.18。. No intraoperative fractures or infections were observed. LLD was detected in 3 cases, one of which underwent revision due to walking difficulty. Dislocation occurred in 3 cases, all within the first 20 cases, however, there was no recurrent dislocation. Conclusion: DAA for THA was deemed to be feasible and safe based on an assessment of operative time, blood loss and complications.

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Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty

Yan

Dong

et al. 2023

JAMA Netw Open

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ImportanceEach approach for primary total hip arthroplasty (THA) has a long learning curve, so a surgeon’s choice to change their preferred approach needs to be guided by clear justifications. However, current evidence does not suggest that any of the THA approaches are more beneficial than others, and the choice of approach is mainly based on the knowledge and experience of the surgeon and individual patient characteristics.ObjectiveTo assess the efficacy and safety associated with different surgical approaches for THA.Data SourcesA comprehensive search of PubMed, EMBASE, and Cochrane databases from inception to March 26, 2022; reference lists of eligible trials; and related reviews.Study SelectionRandomized clinical trials (RCTs) comparing different surgical approaches, including the 2-incision approach, direct anterior approach (DAA), direct lateral approach (DLA), minimally invasive direct lateral approach (MIS-DLA), minimally invasive anterolateral approach (MIS-ALA), posterior approach (PA), minimally invasive posterior approach (MIS-PA), and supercapsular percutaneously assisted total hip arthroplasty (SuperPath), for primary THA.Data Extraction and SynthesisFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2 reviewers independently extracted data on study participants, interventions, and outcomes as well as assessed the risk of bias using the Cochrane risk of bias tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist framework was used to inform a series of random-effects network meta-analyses.Main Outcomes and MeasuresThe outcomes were hip score (range, 0-100, with higher scores indicating better overall hip condition), pain score (range, 0-100, with higher scores indicating more pain), hospitalization time, operation time, quality of life score, blood loss, cup abduction angle, and cup anteversion angle.ResultsOf 2130 retrieved studies, 63 RCTs including 4859 participants (median [IQR] age, 64.0 [60.3-66.5] years; median [IQR] percentage male, 46.74% [38.64%-54.74%]) were eligible for analysis. Eight surgical approaches were evaluated. For hip score, DAA (mean difference [MD], 4.04; 95% CI, 1.92 to 6.16; moderate certainty), MIS-ALA (MD, 3.00; 95% CI, 0.43 to 5.59; moderate certainty), MIS-DLA (MD, 3.37; 95% CI, 1.05 to 5.68; moderate certainty), MIS-PA (MD, 4.46; 95% CI, 1.60 to 7.31; moderate certainty), PA (MD, 4.37; 95% CI, 1.87 to 6.88; high certainty), and SuperPath (MD, 5.00; 95% CI, 0.58 to 9.42; high certainty) were associated with greater improvement in hip score compared with DLA. DLA was associated with lower decrease in pain score than SuperPath (MD, 1.16; 95% CI, 0.13 to 2.20; high certainty) and MIS-DLA (MD, 0.90; 95% CI, 0.04 to 1.76; moderate certainty). PA was associated with shorter operation times compared with 2-incision (MD, −23.85 minutes; 95% CI, −36.60 to −11.10 minutes; high certainty), DAA (MD, −13.94 minutes; 95% CI, −18.79 to −9.08 minutes; moderate certainty), DLA (MD, −10.50 minutes; 95% CI, −16.07 to −4.94 minutes; high certainty), MIS-ALA (MD, −6.76 minutes; 95% CI, −12.86 to −0.65 minutes; moderate certainty), and SuperPath (MD, −13.91 minutes; 95% CI, −21.87 to −5.95 minutes; moderate certainty). The incidence of 6 types of complications did not differ significantly between the approaches.Conclusions and RelevanceIn this study, moderate to high certainty evidence indicated that compared with PA, all surgical approaches except DLA were associated with similar improvements of hip score but longer operation time. DLA was associated with smaller improvement of hip score. The safety of the different approaches did not show significant differences. These findings will help health professionals and patients with better clinical decision-making and also provide references for policy makers.

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Evaluation of the Learning Curve When Transitioning From Posterolateral to Direct Anterior Hip Arthroplasty: A Consecutive Series of 1000 Cases

Cited by 61 publications

References 26 publications

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

Early Experience of Direct Anterior Approach Total Hip Arthroplasty: Analysis of the First 53 Cases

Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty

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