From the Perelman School of Medicine (Pirruccio), University of Pennsylvania, PA, the Department of Orthopaedic Surgery (Dr. Evangelista), University of Pennsylvania, PA, the Department of Orthopedics, South San Francisco Medical Center (Dr. Haw), San Francisco, CA, the Texas Orthopedics (Dr. Goldberg), LLC, Dell Medical School, Austin, TX, and the Department of Orthopaedic Surgery (Dr. Sheth), Pennsylvania Hospital, Orthopaedics University of Pennsylvania, PA.
J Am Acad Orthop Surg. 2020 Nov 15;28(22):930-936. doi: 10.5435/JAAOS-D-19-00752.
Orthopaedic surgeons often cite concern for a learning curve as a barrier to adopting the direct anterior approach (DAA) for total hip arthroplasty (THA) while transitioning from other approaches. Studies both assessing and describing a practical approach and strategy to safely accomplish this transition, as well as the effect on clinical outcomes, are not well described.
This prospective study compares a single surgeon's operative results and complications for the first consecutive 100 direct anterior THA to the last 100 consecutive posterior THA after 7 years in practice. The regimented and disciplined learning strategy used to implement the DAA is detailed in this study. The data were analyzed using univariate and multivariate regression models.
Univariate analyses identified significant differences in sex, age, Asian race, and diagnostic cause for THA between the two cohorts. Multivariate analyses controlled for these differences and showed that relative to posterior THA, direct anterior THA cases were associated with 7-minute longer procedures (P = 0.002) and lengths of stay that were 0.7 days fewer (P = 0.013). No significant differences were present in the estimated blood loss, and importantly, no significant differences in death or surgical complication rates between cohorts.
This study suggests that the DAA for THA can be safely implemented without the increased and adverse risk to the patient when a structured learning process is maintained and meticulously performed.
骨科医生在从其他入路过渡到全髋关节置换术（THA）的直接前入路（DAA）时，常以担心学习曲线为障碍。虽然有研究评估和描述了一种安全过渡的实用方法和策略，但对于其对临床结果的影响，研究还不够充分。
本前瞻性研究比较了一位外科医生在实践 7 年后，前 100 例连续直接前路 THA 和后 100 例连续后路 THA 的手术结果和并发症。本研究详细介绍了实施 DAA 时所使用的有计划、有纪律的学习策略。使用单变量和多变量回归模型对数据进行分析。
单变量分析发现，两组患者在性别、年龄、亚洲人种和 THA 诊断病因方面存在显著差异。多变量分析控制了这些差异，结果表明，与后路 THA 相比，直接前路 THA 手术的手术时间长 7 分钟（P = 0.002），住院时间减少 0.7 天（P = 0.013）。两组间的估计失血量无显著差异，重要的是，两组间的死亡率和手术并发症发生率无显著差异。
本研究表明，当保持并精心执行结构化学习过程时，直接前路 THA 可以安全实施，而不会增加患者的风险和不良后果。
