Advantages of an Anterior-Based Muscle-Sparing Approach in Transitioning From a Posterior Approach for Total Hip Arthroplasty: Minimizing the Learning Curve |
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| Institution: | 1. Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT;2. Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR;3. OrthoLA Adult Reconstruction, Thibodaux, LA;1. Rothman Orthopaedic Institute, Philadelphia, PA;2. Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;3. Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel;1. Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, FL;2. Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA;3. Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL;4. Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY;5. Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH;1. Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, New York, NY;2. Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA;3. Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY;4. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY;5. Department of Orthopaedic Surgery, Duke University, Durham, NC;1. Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom;2. University of Exeter Medical School, College of Medicine and Health, St Luke''s Campus, Exeter, United Kingdom;3. Signidat, Roderwolde, the Netherlands |
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| Abstract: | BackgroundEnthusiasm for anterior-based approaches for total hip arthroplasty (THA) continues to increase but there is concern for increased complications during the learning curve period associated. This study aimed to investigate if there was a difference in perioperative variables, intraoperative and immediate postoperative complications, or patient-reported outcomes when transitioning from a mini-posterior approach (mPA) to an anterior-based muscle-sparing (ABMS) approach for THA.MethodsRetrospective cohort study on the first 100 primary THA cases (n = 96 patients) of the senior author (August 2016 to August 2017) using the ABMS approach. These cases were compared to primary THA cases done the year prior (July 2015 to July 2016, n = 91 cases in 89 patients) using an mPA. Data were extracted and analyzed via gamma regression with robust standard errors and using generalized estimating equation regression.ResultsWe found no difference in the estimated blood loss (P = .452) and surgical time (P = .564) between the cohorts. The ABMS cases had a slightly shorter length of stay (P = .001) with an adjusted mean length of stay of 1.53 days (95% confidence interval 1.4-1.6) compared to 1.85 days (95% confidence interval 1.8-1.9) in the mPA cases. There was no difference in the frequency of immediate postoperative complications (all, P > .05). There was no difference in the adjusted mean change in patient-reported outcomes (all P > .05). In the ABMS group, there was no difference in surgical time or physical function computerized adaptive test between the first 20 cases (reference) and each subsequent group of 20 cases (all P > .05).ConclusionThis study demonstrates no associated learning curve for an experienced senior surgeon when switching routine THA approach from mPA to ABMS. We advise careful interpretation of our results, as they may not apply to all surgeons and practices.Level of EvidenceLevel III Therapeutic Study: retrospective comparative study. |
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| Keywords: | total hip arthroplasty complications anterior-based muscle-sparing approach outcomes patient-reported outcomes |
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