Learning Curve for the Anterior Approach Total Hip Arthroplasty

Goytia, Robin N.; Jones, Lynne C.; Hungerford, Marc W.

doi:10.3113/jsoa.2012.0078

Cited by 70 publications

(43 citation statements)

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“…After removal of duplicates and verification of eligibility, 121 papers were assessed. Three papers were excluded because they used the same study population as another included study [5,21,22], and another 80 because they did not report on the study outcome or they reported on non-consecutive, selected cohorts ( Fig. 1).…”

Section: Search Resultsmentioning

confidence: 99%

Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

Geest

Fennema²,

Lenaerts³

et al. 2015

Arch Orthop Trauma Surg

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Section: Search Resultsmentioning

confidence: 99%

Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

Geest

Fennema²,

Lenaerts³

et al. 2015

Arch Orthop Trauma Surg

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“…Several studies have suggested no significant difference in early outcomes, whereas others cited increased complication rates, increased blood loss and surgical time, and a steep learning curve causing poorer outcomes during the training period [7], [8], [12], [24], [25]. It should be noted that influence of both demographic disparities and learning curve issues were minimized in our study, as patient demographics were found to be similar between the 2 groups and both contributing surgeons had significant prior experience in THA using their respective approaches.…”

Section: Discussionmentioning

confidence: 99%

Financial impact of total hip arthroplasty: a comparison of anterior versus posterior surgical approaches

2017

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BackgroundCompared to the posterior approach, the anterior approach to total hip arthroplasty (THA) offers the potential for an accelerated recovery secondary to less dissection and therefore less pain in the immediate postoperative period. This offers potential financial benefit through a reduction in length of stay. This study retrospectively reviewed 98 anterior approach and 69 posterior approach THA cases (N = 167) to compare perioperative outcomes and cost-effectiveness.MethodsPatients who underwent anterior approach THA were discharged sooner than those who underwent posterior approach THA.ResultsThe anterior approach was also less expensive per patient than the posterior approach. Overall, differences in perioperative outcomes between these approaches to THA are less robust than previously reported. There is a significant difference in operative cost between these surgical approaches.ConclusionsAlthough there are many sources for this difference in cost, the predominant contributor is surgeon implant preference.

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“…8–13 There is also a well-described learning curve with DAA leading to concerns with adopting this technique for THA. 14 A small incision and minimal soft tissue dissection with the DAA may also lead to potential liabilities including suboptimal implant position, increased risk of femoral perforation, and increased risk of intraoperative fracture. 10,13 Reaming and preparation of both the femoral and acetabular components using the DAA have been identified as being more difficult, especially for surgeons less familiar with the approach.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Radiographic Outcomes After Total Hip Arthroplasty Between the Posterior Approach and Direct Anterior Approach With Intraoperative Fluoroscopy

Lin

Bendich

et al. 2017

The Journal of Arthroplasty

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Background Radiographic outcomes after total hip arthroplasty (THA) have been linked to clinical outcomes. The direct-anterior approach (DAA) for THA has been criticized by some for providing limited exposure and compromised implant position, but allows for routine use of intra-operative fluoroscopy. We sought to determine whether radiographic measurements differed by THA approach using prospective cohorts. Methods Two reviewers blinded to surgical approach examined 194 radiographs, obtained 4–6 weeks after primary THA, and obtained measurements for acetabular inclination angle, acetabular anteversion, radiographic limb length discrepancy (LLD), and femoral offset. All surgeries were performed at a tertiary academic medical center in rural New England by an experienced fellowship-trained arthroplasty surgeon. Measurements for inclination angle, anteversion, LLD, and offset were made into binary yes/no responses based on whether the mean measurement (between the two reviewers) was acceptable or not based on established criteria. Multivariate logistic regression analyses were performed using pre-operative and intra-operative characteristics to identify predictors of acceptability for each measurement. Results The DAA group had higher rates of acceptable acetabular angle (96 vs. 85%, P=0.005), and was protective against an unacceptable angle in an adjusted predictive model (OR 0.16, P=0.005). There were no significant differences between approaches for acceptable anteversion, LLD, or offset. Body mass index of 30–34 was associated with higher odds of unacceptable inclination angle compared to the non-obese group (aOR 6.82, P=0.013). Conclusion DAA for THA was associated with lower odds of unacceptable inclination angle compared to the posterior approach, with no differences in anteversion, LLD, or offset.

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Learning Curve for the Anterior Approach Total Hip Arthroplasty

Cited by 70 publications

References 0 publications

Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

Financial impact of total hip arthroplasty: a comparison of anterior versus posterior surgical approaches

A Comparison of Radiographic Outcomes After Total Hip Arthroplasty Between the Posterior Approach and Direct Anterior Approach With Intraoperative Fluoroscopy

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