Abstract
BackgroundThere are concerns regarding the complications encountered during the learning curve when switching to a direct anterior approach (DAA) for total hip arthroplasty (THA). The purpose of our study is to report our outcomes and complications after adopting a new approach in a Chinese patient population.MethodsFrom 2016 to 2018, a single surgeon’s first 100 cases with unilateral DAA for THA were reviewed. The patients were divided into 2 groups, the first 50 cases were designated as group A and the second 50 cases were designated as group B. The preoperative, intraoperative, and postoperative clinical data were analyzed. The cumulative summation method (CUSUM) was used to determine the learning curve.ResultsThere was a significant decrease in the complication rate from 44% in the first 50 cases to 16% in the second 50. The first 50 cases showed a significant increase in operating time, length of hospitalization, fluoroscopy, and complications. There was no significant difference in implant position, postoperative leg length discrepancy (LLD), Harris score, or creatine kinase. CUSUM analysis showed that complication rates and operating time reached acceptable and steady state after 88 cases and 72 cases respectively.ConclusionsAdopting DAA in a Chinese patient population has its own unique considerations and challenges. Even in the hands of an experienced surgeon, DAA is still a technically demanding procedure.
Highlights
There are concerns regarding the complications encountered during the learning curve when switching to a direct anterior approach (DAA) for total hip arthroplasty (THA)
The first 50 cases showed an increase in operating time, fluoroscopic time, length of hospitalization (LOH), and incidence of complications that were statistically significant
There was no significant difference between the two groups in blood transfusion rate, implant position, postoperative leg length discrepancy (LLD), postoperative Harris score, or creatine kinase level
Summary
There are concerns regarding the complications encountered during the learning curve when switching to a direct anterior approach (DAA) for total hip arthroplasty (THA). As surgical techniques and instruments have improved for the DAA approach, several studies have shown advantages over other approaches, such as less soft tissue injury, reduced hospital stay, and a more rapid early recovery [5]. Despite these advantages, DAA’s demanding surgical technique and the potential need for auxiliary equipment have been reported as reasons which have limited further development [6, 7]. We hypothesized that a steady state in terms of operative time and complications could be achieved
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