Characterizing the Learning Curve for Anterior Total Hip Arthroplasties Using the Forgotten Joint Score

Abstract

There are 2 approaches to a total hip arthroplasty (THA) that are commonly used by orthopedic surgeons. While the posterior approach has traditionally been used more frequently, the anterior approach has recently gained popularity because it has been shown to improve patient outcomes. Still, the challenge of learning any new surgical approach during practice can pose its own complications. This study’s aim was to evaluate outcomes of the different approaches, overall and along a chronological timeline, in order to better understand the learning curve for transitioning from a posterior to an anterior approach for THAs. While other studies have examined this learning curve using operating room times and procedural-specific data, this study investigates this topic through the patient’s perspective by using the Forgotten Joint Score (FJS) questionnaire to evaluate patient-perceived pain. A total of 246 patients who underwent a THA procedure performed by a single orthopedic surgeon at MedStar Washington Hospital Center were contacted. FJS questionnaire data from 39 patients (47 THAs) were analyzed. Despite results showing a higher mean FJS for the anterior approach (mean score, 77.55; standard error of the mean [SEM], 5.27; n = 29 THAs) than the posterior approach (mean score, 69.42; SEM, 7.19; n = 18 THAs ), there was no significant difference found between groups (P = .38). Furthermore, based on 2-way analysis of variance, neither the surgical approach nor the surgery year were significantly associated with FJS. Overall, while there are still important considerations in surgical practice regarding learning a new procedure, our data did not suggest that the learning curve of transitioning from the posterior to the anterior approach for THAs significantly affected clinical outcomes; however, the data were limited by a small sample size due to poor survey response rate.