First Experiences with the Direct Anterior Approach in Lateral Decubitus Position: Learning Curve and 1 Year Complication Rate

2015 ◽  
Vol 25 (3) ◽  
pp. 251-257 ◽  
Author(s):  
Wietse P.R. Melman ◽  
Bas P. Mollen ◽  
Boudewijn J. Kollen ◽  
Cees C.P.M. Verheyen
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Lateral Decubitus Position ◽  
Position Learning ◽  
Lateral Decubitus

scholarly journals Direct Anterior Approach for Total Hip Arthroplasty in the Lateral Decubitus Position Versus Supine Position: A Random Clinical Trial

2021 ◽  
Author(s):  
Yao Xiao ◽  
Zhanglai Li ◽  
Feitai Lin ◽  
Yiyuan Zhang ◽  
Yan Weng ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Supine Position ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Lateral Position ◽  
Lateral Decubitus Position ◽  
Population Characteristics ◽  
Total Hip ◽  
Lateral Decubitus

Abstract Background: Direct anterior approach (DAA）for total hip arthroplasty (THA）could be performed either in the lateral decubitus position or supine position. However, there is an obvious absence of literature regarding the differences, which position may be more conducive to recovery, technically more demanding, associated with component malposition or more complications. Methods: From Jan.1st, 2020 to oct.1st, 2020, 45 patients were recruited for primary unilateral THA using the DAA. In total, 27 patients (60%) underwent THAs using the DAA in the supine position, and 18 patients (40%) in the lateral decubitus position. All surgeries were performed by a high-volume surgeon. Technical information, clinical and radiographic outcomes, SF-12 and patient-reported outcomes such as WOMAC were evaluated. All the date were tested with Generalized Linear Mixed Models Analysis, GLM Repeated Measurement Analysis, Independent samples t-test or Pearson’s chi-square test.Results: There were no differences in Population characteristics before surgery. The operation time, length of stay and blood loss in the LP group and the SP group were no differences. The prosthesis of the two groups were in a good position. pre-operative and the first and third day after the surgery of CK-MB and Hb,pre-operative and the last follow-up of HSS,WOMAC,UCLA,VAS,SF-12,and pre-operation and post-operation of Offset,FA and LLD, all the above indicators show no significant difference. And the incidence of complications in the lateral position was lower than that in the supine position.Conclusion: Both THA via DAA in the lateral decubitus position and in the supine position produced excellent clinical outcomes. From the perspective of the occurrence of complications, we are more inclined to use the lateral position.

The Learning Curve of the Direct Anterior Approach without Traction Table in Total Hip Replacement: Using the LC-CUSUM Method

2019 ◽  
Vol 03 (01) ◽  
pp. 041-047 ◽  
Author(s):  
Koen Steentjes ◽  
Stefan Beekhuizen ◽  
Wouter Eilander ◽  
Wendy Meesters ◽  
Paulien van Kampen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Total Hip Replacement ◽  
Complication Rate ◽  
Hip Replacement ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Duration Of Surgery ◽  
Cusum Method

AbstractThe surgical approach for total hip replacement (THR) depends on surgeon preference or the preference and experience of the surgeon with a specific approach. The aim of this study was to analyze the learning curve of the direct anterior approach (DAA) using the cumulative summation test for learning curve (LC-CUSUM). A retrospectively collected database of 400 THRs using the DAA (January 2010–September 2014) at a single center by a single surgeon. The learning curve was analyzed by determining the duration of surgery, blood loss, and number of complications. All 400 primary THRs were reviewed. Based on the LC-CUSUM, duration of surgery, and surgical failure, the learning curve plateau was achieved after the 19th surgery and the curve follows a substantially negative trend. The average duration of surgery changed significantly for the first hundred (78 minutes) to the last hundred (61 minutes). A significant decrease in blood loss was observed as well. A total of 17 (4.25%) complications occurred, with reduction of the complication rate as surgeons' experience increases. The authors' study did not show the long learning curve as previously described in the literature. The number of complications was small, and there was a significant decrease in duration of surgery, blood loss, and number of complications as surgeon's experience increases. The authors suggest that the educational environment of a teaching hospital, combined with the use of the DAA as a standard approach for all primary THRs and supervision of experienced surgeons, contribute to the favorable learning curve with a low complication rate.

The Surgeon Mentor Program: Outcomes of Total Hip Arthroplasty via the Direct Anterior Approach

2021 ◽  
Author(s):  
Melinda Jiang ◽  
Mark Inglis ◽  
David Morris ◽  
Nathan Eardley-Harris ◽  
Christopher J. Wilson
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Complication Rate ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Initial Increase ◽  
Mentoring Program ◽  
Total Hip

AbstractThe direct anterior approach (DAA) for total hip arthroplasty has been increasing in popularity due to potential benefits including less pain, faster recovery, decreased risk of dislocation, and a reduced length of stay. The DAA has been described by many to have a steep learning curve owing to its greater risk of complications when first using the approach. The primary aim of this study was to design and implement a specific surgeon mentor program in an attempt to reduce the learning curve of the DAA. Surgeons completed the surgical education and mentoring program designed to reduce the initial increase in complication rate when first learning the DAA in a public hospital setting. A retrospective review of clinical and radiological outcomes on the first 67 cases was then conducted. Of these, 43 cases were eligible for inclusion. The 43 patients in this study had a mean age of 66.7, BMI of 26.7, and 57% of them were female. Follow-up was between 39 and 49 months, with a mean of 46 months. There were no fractures, dislocations, or blood transfusions. One patient required revision for deep infection. The mean length of stay was 2.81 days. At 6 weeks postoperative, 86% were independently mobile, 9.3% were using a cane, and 4.7% were being weaned off a walker. The radiological assessments found a mean cup abduction of 39.9 ± 5.1 degrees, mean femoral offset of 1.6 ± 5.5 mm, and a total hip offset of 1.3 ± 7 mm greater than the contralateral hip. Patients had a mean leg length discrepancy of −0.9 ± 5.9 mm. In conclusion, a surgeon mentoring program was designed and implemented to reduce the learning curve of the DAA in our center, with satisfactory 3-year clinical and radiological outcomes achieved. This study provides preliminary support for the potential utility of the mentoring program in facilitating other centers in safely introducing the DAA into their practice without an initial increase in complication rate.

scholarly journals Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 15 ◽  
Author(s):  
Constant Foissey ◽  
Mathieu Fauvernier ◽  
Cam Fary ◽  
Elvire Servien ◽  
Sébastien Lustig ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Operating Time ◽  
Surgical Techniques ◽  
Direct Anterior Approach ◽  
Clinical Results ◽  
Total Hip ◽  
Significant Difference

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

Perioperative complication rate of one-stage bilateral total hip arthroplasty using the direct anterior approach

2016 ◽  
Vol 21 (5) ◽  
pp. 658-661 ◽  
Author(s):  
Tatsuya Tamaki ◽  
Kazuhiro Oinuma ◽  
Yoko Miura ◽  
Hidetaka Higashi ◽  
Ryutaku Kaneyama ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Complication Rate ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
One Stage ◽  
Perioperative Complication

scholarly journals Learning Curve of the Direct Anterior Approach for Hip Arthroplasty

2020 ◽  
Vol 55 (2) ◽  
pp. 143
Author(s):  
Dong Hun Ham ◽  
Woo Chull Chung ◽  
Byeong Yeol Choi ◽  
Jong Eun Choi
Keyword(s):  
Learning Curve ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach
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