Skip to main content
SpringerLink
Log in

Orthopaedic trauma surgeons and direct anterior total hip arthroplasty: evaluation of learning curve at a level I academic institution

  • Original Article • HIP - TRAUMA
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Interest in the direct anterior approach for total hip arthroplasty has increased over recent years; however, the potential for substantial complications exists, especially during the surgeon’s learning curve. We evaluated the change in various metrics to help identify a single surgeon’s learning curve. Additionally, we examined whether the learning curve was different for primarily arthroplasty versus trauma-trained surgeons.

Methods

We reported outcomes from the first 50 total hip arthroplasties performed through a direct anterior approach by a trauma fellowship-trained orthopaedic surgeon. Intraoperative and post-operative clinical outcomes were evaluated, including length of procedure, estimated blood loss, length of hospitalization, disposition to home versus care facility, need for blood transfusion, and complications. Previous reported learning curve outcomes were analysed with a comparison between those who are primarily arthroplasty specialists versus those who include hip arthroplasty as only a portion of their practice.

Results

A significant difference in surgical time from 135 to 113 min was observed between the first 25 cases and the last 25. Estimated blood loss (EBL) and lateral femoral cutaneous nerve injury rates decreased but not to a significant degree. Among reported learning curves, surgical time was significantly lower among fellowship-trained arthroplasty specialists when compared with other surgeons.

Conclusion

Our data support that surgeons who perform primarily joint arthroplasty will likely have a decreased surgical time, but similar EBL compared to those who include arthroplasty as only a portion of their practice, however, a number of confounding variables do exist, and additional investigation is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Berend K, Lombardi AJ, Seng B, Al E (2009) Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. J Bone Jt Surg Am 91:107–120

    Article  Google Scholar 

  2. Paillard P (2007) Hip replacement by a minimal anterior approach. Int Orthop 31:13–15

    Article  PubMed Central  Google Scholar 

  3. Repantis T, Bouras T, Korovessis P (2015) Comparison of minimally invasive approach versus conventional anterolateral approach for total hip arthroplasty: a randomized controlled trial. Eur J Orthop Surg Traumatol Orthop Traumatol 25:111–116. doi:10.1007/s00590-014-1428-x

    Article  CAS  Google Scholar 

  4. York P, Smarck C, Judet T (2016) Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery. Int Orthop. doi:10.1007/s00264-016-3125-3

    PubMed  Google Scholar 

  5. Pala E, Trono M, Bitonti A, Lucidi G (2016) Hip hemiarthroplasty for femur neck fractures: minimally invasive direct anterior approach versus postero-lateral approach. Eur J Orthop Surg Traumatol 26:423–427. doi:10.1007/s00590-016-1767-x

    Article  CAS  PubMed  Google Scholar 

  6. Homma Y, Baba T, Kobayashi H et al (2016) Benefit and risk in short term after total hip arthroplasty by direct anterior approach combined with dual mobility cup. Eur J Orthop Surg Traumatol 26:619–624. doi:10.1007/s00590-016-1808-5

    Article  PubMed  Google Scholar 

  7. Jewett B, Collis D (2007) High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res 469:503–507

    Article  Google Scholar 

  8. Pilot P, Kerens B, Draijer W, Al E (2006) Is minimally invasive surgery less invasive in total hip replacement? A pilot study. Injury 37S:S17–S23

    Article  Google Scholar 

  9. Homma Y, Baba T, Ochi H et al (2016) Greater trochanter chip fractures in the direct anterior approach for total hip arthroplasty. Eur J Orthop Surg Traumatol 26:605–611. doi:10.1007/s00590-016-1798-3

    Article  PubMed  Google Scholar 

  10. Alecci V, Valente M, Crucil M, Al E (2011) Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 12:123–129

    Article  PubMed  PubMed Central  Google Scholar 

  11. De Geest T, Vansintjan P, De Loore G (2013) Direct anterior total hip arthroplasty: complications and early outcome in a series of 300 cases. Acta Orthop 79:166–173

    Google Scholar 

  12. Post Z, Orozco F, Diaz-Ledezma C, Al E (2014) Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg 22:595–603

    Article  PubMed  Google Scholar 

  13. Spaans A, van den Hout J, Bolder S (2012) High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 83:342–346

    Article  PubMed  PubMed Central  Google Scholar 

  14. Woolson S, Pouliot M, Huddleston J (2009) Primary total hip arthroplasty using an anterior approach and a fracture table: short-term results from a community hospital. J Arthroplast 24:999–1005

    Article  Google Scholar 

  15. American Academy of Orthopaedic Surgeons (2004) Orthopaedic practice in the US. 2005–2006. Final report

  16. Seng B, Berend K, Ajluni A, Al E (2009) Anterior-supine minimally invasive total hip arthroplasty: defining the learning curve. Orthop Clin North Am 40:343–350

    Article  PubMed  Google Scholar 

  17. De Geest T, Fennema P, Lenaerts G, Al E (2015) Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis. Arch Orthop Trauma Surg 135:1183–1192. doi:10.1007/s00402-015-2258-y

    Article  PubMed  Google Scholar 

  18. Alexandrov T, Ahlmann E, Menendez L (2014) Early clinical and radiographic results of minimally invasive anterior approach hip arthroplasty. Adv Orthop. doi:10.1155/2014/954208

    PubMed  PubMed Central  Google Scholar 

  19. Yi C, Agudelo J, Dayton M, Al E (2013) Early complications of anterior supine intermuscular total hip arthroplasty. Orthopedics 36:e276–e281

    Article  PubMed  Google Scholar 

  20. Bhargava T, Goytia R, Jones L, Al E (2010) Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty. Orthopedics 33:472

    PubMed  Google Scholar 

  21. D’Arrigo C, Speranza A, Monaco E, Al E (2009) Learning curve in tissue sparing total hip replacement: comparison between different approaches. J Orthop Trauma 10:47–54

    Article  Google Scholar 

  22. Oinuma K, Eingartner C, Saito Y, Al E (2007) Total hip arthroplasty by a minimally invasive, direct anterior approach. Oper Orthop Traumatol 19:310–326

    Article  PubMed  Google Scholar 

  23. Zawadsky M, Paulus M, Murray P, Al E (2013) Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplast 29:1256–1260

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Colorado, 12631 E 17th Ave, Rm 4501, B202, Aurora, CO, 80045, USA

    Philip J. York & Stephanie L. Logterman

  2. Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA

    David J. Hak & Cyril Mauffrey

  3. First Department of Orthopaedics, Attikon University Hospital, 1 Rimini Street, 12462, Haidari, Athens, Greece

    Andreas Mavrogenis

Authors
  1. Philip J. York
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie L. Logterman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David J. Hak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andreas Mavrogenis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cyril Mauffrey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cyril Mauffrey.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest in relation to this manuscript.

Ethical approval

IRB ethical approval was obtained prior to the start of this study.

Funding

There was no funding received for this study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Authorship statement: Each author confirms that he or she was involved in the development, writing, and editing of this manuscript. Each has had the opportunity to review the final version of the submitted work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

York, P.J., Logterman, S.L., Hak, D.J. et al. Orthopaedic trauma surgeons and direct anterior total hip arthroplasty: evaluation of learning curve at a level I academic institution. Eur J Orthop Surg Traumatol 27, 421–424 (2017). https://doi.org/10.1007/s00590-017-1937-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-017-1937-5

Keywords

Search

Navigation