Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
Division of Orthopaedic Surgery, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
Int Orthop. 2021 Aug;45(8):1971-1982. doi: 10.1007/s00264-021-04986-7. Epub 2021 Feb 24.
The direct anterior approach (DAA) for total hip arthroplasty (THA) is a muscle-sparing approach thought to have less post-operative pain and quicker recovery, with similar functional outcomes to other approaches. However, it is technically challenging and transitioning surgeons may experience increased complication rates. The purpose of this systematic review is to identify reported learning curves associated with the DAA.
Three databases (MEDLINE, Embase, and Web of Science) were searched using terms including "total hip arthroplasty," "direct anterior approach," and "learning curve." Study characteristics, patient demographics, learning curve analyses, and complications were abstracted.
Twenty-one studies met inclusion criteria, with a total of 9738 patients (60% female), an average age of 63.7 years (range: 13-94), body mass index of 27.0 kg/m (range: 16.8-58.9), and follow-up of 19 months (range: 1.5-100). There were five retrospective cohort studies and 13 case series representing fair methodological quality. Six studies depicted a true learning curve, with mean operative time of 156.59 ± 41.71 minutes for the first case, 93.18 ± 14.68 minutes by case 30, and 80.45 ± 12.28 minutes by case 100. Mean complication rate was 20.8 ± 12.7% in early groups and decreased to 7.6 ± 7.1% in late groups.
This review demonstrated a substantial learning curve associated with the DAA to THA. Operative time plateaued after approximately 100 cases. Complication rates decreased substantially from early to late groups.
全髋关节置换术（THA）的直接前入路（DAA）是一种肌肉保留入路，据认为术后疼痛较轻，恢复较快，与其他入路相比功能结果相似。然而，它具有技术挑战性，过渡到该入路的外科医生可能会经历更高的并发症发生率。本系统评价的目的是确定与 DAA 相关的报告学习曲线。
使用包括“全髋关节置换术”、“直接前入路”和“学习曲线”等术语，在 MEDLINE、Embase 和 Web of Science 三个数据库中进行检索。提取研究特征、患者人口统计学、学习曲线分析和并发症。
21 项研究符合纳入标准，共纳入 9738 例患者（60%为女性），平均年龄 63.7 岁（范围：13-94 岁），体重指数 27.0kg/m（范围：16.8-58.9），随访时间为 19 个月（范围：1.5-100 个月）。有 5 项回顾性队列研究和 13 项病例系列研究，方法学质量为中等。6 项研究描绘了真正的学习曲线，第 1 例的平均手术时间为 156.59±41.71 分钟，第 30 例为 93.18±14.68 分钟，第 100 例为 80.45±12.28 分钟。早期组的平均并发症发生率为 20.8%±12.7%，晚期组降至 7.6%±7.1%。
本综述表明，DAA 行 THA 存在显著的学习曲线。术后 100 例左右手术时间趋于平稳。并发症发生率从早期组到晚期组显著下降。
