Pujol Oriol, Soza Diego, Lara Yuri, Castellanos Sara, Hernández Alejandro, Barro Víctor
Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain.
Hip Surgery Unit, Orthopedic Surgery Department, Josep Trueta University Hospital, Girona, Spain.
J Orthop. 2021 Jul 13;26:72-78. doi: 10.1016/j.jor.2021.07.014. eCollection 2021 Jul-Aug.
It remains controversial whether the direct anterior approach (DAA) or the posterior approach (PA) allows better restoration of hip biomechanics after total hip arthroplasty (THA). Besides, it is not certain which approach is best for a novice surgeon to avoid implant malposition, neither during the learning curve nor once the curve plateau has been reached.
We performed a retrospective cohort study of THAs operated on between 2014 and 2019 by a single novice surgeon (DAA, n = 187; PA, n = 184). The surgeon used both approaches, and thus went through parallel learning curves.
While the DAA presented a greater number of acetabular cup implantations within Lewinnek's "safe zone" for inclination (84.5% vs. 79.3%; p = 0.003), the PA returned superior results for anteversion (77.7% vs. 68.4%; p = 0.000). The PA showed a tendency to verticalize acetabular cups, while the DAA tended to antevert them. The DAA resulted in fewer patients with leg length discrepancy (3.2% vs. 8.2%, p = 0.041). No differences were found in stem coronal alignment or femoral offset.
Both approaches are safe and reliable for restoring hip biomechanics through THA surgery during the learning curve of a novice hip surgeon. Similar radiological outcomes are also seen once the surgeon has reached the learning curve plateau.
全髋关节置换术（THA）后，直接前路（DAA）或后路（PA）是否能更好地恢复髋关节生物力学仍存在争议。此外，对于新手外科医生而言，不确定哪种方法最能避免植入物位置不当，无论是在学习曲线期间还是达到曲线平稳期之后。
我们对一位新手外科医生在2014年至2019年间进行的THA手术进行了回顾性队列研究（DAA组，n = 187；PA组，n = 184）。该外科医生使用了两种方法，因此经历了平行的学习曲线。
虽然DAA在Lewinnek倾斜“安全区”内的髋臼杯植入数量更多（84.5%对79.3%；p = 0.003），但PA在前倾方面的结果更佳（77.7%对68.4%；p = 0.000）。PA显示出使髋臼杯垂直化的趋势，而DAA则倾向于使其前倾。DAA导致腿长差异的患者较少（3.2%对8.2%，p = 0.041）。在股骨柄冠状位对线或股骨偏心距方面未发现差异。
在新手髋关节外科医生的学习曲线期间，两种方法通过THA手术恢复髋关节生物力学都是安全可靠的。一旦外科医生达到学习曲线平稳期，也会出现类似的放射学结果。
