Garbarino Luke, Gold Peter, Sodhi Nipun, Iturriaga Cesar, Mont Michael A, Boraiah Sreevathsa
Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA.
Department of Orthopaedic Surgery, Plainview Hospital, Northwell Health, Plainview, NY, USA.
Arthroplast Today. 2021 Jan 12;7:98-104. doi: 10.1016/j.artd.2020.11.019. eCollection 2021 Feb.
The direct anterior approach (DAA) used for primary total hip arthroplasty has been shown to improve early postoperative outcomes, but prior studies have identified a marked learning curve for surgeons transitioning to this approach. However, these studies do not capture surgeons with postgraduate fellowship training in DAA. Therefore, the purpose of this study was to evaluate the learning curve by comparing perioperative outcomes for the first 100 to latter 100 cases and first 50 to final 50 cases.
The first 200 consecutive primary total hip arthroplasties performed by a single surgeon were prospectively followed up for up to 2 years postoperatively. Data on demographic and perioperative factors, 90-day readmissions, and short- and long-term complications were collected. Radiographic outcomes included acetabular cup anteversion and abduction measurements. Logistic regressions were used to calculate odds ratios and confidence intervals for surgical time greater than 2 hours.
The first 100 and second 100 cases had significant differences in operative times (118.1 vs 110.4 minutes, = .009), acetabular abduction (38.3 vs 35.5 degrees, = .001) and anteversion (13.5 vs 15.1 degrees, = .009), and incidence of neuropraxia (41 vs 9%, < .001). Estimated blood loss, transfusions, discharge disposition, length of stay, readmission, and other complications had no statistical significance between the first and second 100 cases. The first 50 cases had higher odds of surgical time greater than 2 hours (odds ratio = 5.2, 95% confidence interval = 1.84-14.75, = .002) than the final 50 cases.
When compared with the existing literature, incorporation of DAA into fellowship training can lead to reduction in fractures and reoperation rates.
用于初次全髋关节置换术的直接前路（DAA）已被证明可改善术后早期结果，但先前的研究已确定外科医生向这种方法过渡存在明显的学习曲线。然而，这些研究并未涵盖接受过DAA研究生培训的外科医生。因此，本研究的目的是通过比较前100例与后100例以及前50例与最后50例的围手术期结果来评估学习曲线。
对由一名外科医生连续进行的前200例初次全髋关节置换术进行前瞻性随访，术后长达2年。收集有关人口统计学和围手术期因素、90天再入院情况以及短期和长期并发症的数据。影像学结果包括髋臼杯前倾和外展测量。使用逻辑回归计算手术时间大于2小时的比值比和置信区间。
前100例和后100例在手术时间（118.1对110.4分钟，P = 0.009）、髋臼外展（38.3对35.5度，P = 0.001）和前倾（13.5对15.1度，P = 0.009）以及神经失用症发生率（41%对9%，P < 0.001）方面存在显著差异。前100例与后100例之间的估计失血量、输血情况、出院处置、住院时间、再入院情况和其他并发症无统计学意义。前50例手术时间大于2小时的几率（比值比 = 5.2，95%置信区间 = 1.84 - 14.75，P = 0.002）高于最后50例。
与现有文献相比，将DAA纳入专科培训可降低骨折和再次手术率。
