Owen Trevor M, Horberg John V, Corten Kristoff, Moskal Joseph T
Department of Orthopaedic Surgery, Virginia Tech Carilion Clinic, Roanoke, VA, USA.
European Hip Clinic, Herselt, Belgium.
Arthroplast Today. 2022 May 18;15:167-173. doi: 10.1016/j.artd.2022.03.026. eCollection 2022 Jun.
When performing a total hip arthroplasty via the direct anterior approach (DAA), many orthopedic surgeons utilize an orthopedic traction table. This technique requires an expensive table, time for positioning, staff to operate the table, and time-consuming transitions when preparing the femur. Some surgeons advocate for an "off-table" technique to avoid these difficulties. In this paper, we compare operating room efficiency between on-table and off-table techniques.
We retrospectively reviewed patients undergoing total hip arthroplasty by a single surgeon across the transition from on-table to off-table DAA technique. Three cohorts were defined; the last 40 on-table hips, the first 40 off-table hips, followed by the second 40 hips. Timestamps from the operative record were recorded to calculate setup, surgical, takedown, and total room time. Implant fixation, patient demographic data, comorbidities, and complications were recorded.
From cohort 1 to 2, there was a 7-minute (14.44%, = .0002) improvement in setup time but no change in total room time. From cohort 2 to 3, there was an additional 7-minute (15.47%, < .0001) improvement in setup time, 32-minute (25.88%, < .0001) improvement in surgical time, and 40-minute (21.96%, < .0001) improvement in total room time yielding cumulative changes from cohort 1 to 3 of 15 minutes (27.68%, < .0001), 28 minutes (23.11%, < .0001), and 43 minutes (23.37%, < .0001), respectively. There was no correlation between height, weight, or body mass index and time at any interval.
Conversion to an off-table DAA technique offers an improvement in operating room efficiency. This is seen in setup, operative, and total room time. Implementation could allow for an additional case each day.
在通过直接前路（DAA）进行全髋关节置换术时，许多骨科医生会使用骨科牵引台。该技术需要一台昂贵的手术台、定位时间、操作手术台的工作人员，并且在准备股骨时需要耗时的转换过程。一些外科医生提倡采用“台下”技术以避免这些困难。在本文中，我们比较了台上和台下技术的手术室效率。
我们回顾性分析了由同一位外科医生进行全髋关节置换术的患者，涵盖了从台上DAA技术向台下DAA技术转变的过程。定义了三个队列；最后40例台上髋关节置换病例、前40例台下髋关节置换病例，以及随后的40例髋关节置换病例。记录手术记录中的时间戳，以计算准备时间、手术时间、拆除时间和总手术室时间。记录植入物固定情况、患者人口统计学数据、合并症和并发症。
从队列1到队列2，准备时间缩短了7分钟（14.44%，P = .0002），但总手术室时间没有变化。从队列2到队列3，准备时间又缩短了7分钟（15.47%，P < .0001），手术时间缩短了32分钟（25.88%，P < .0001），总手术室时间缩短了40分钟（21.96%，P < .0001），从队列1到队列3的累积变化分别为15分钟（27.68%，P < .0001）、28分钟（23.11%，P < .0001）和43分钟（23.37%，P < .0001）。在任何时间段，身高、体重或体重指数与时间之间均无相关性。
转换为台下DAA技术可提高手术室效率。这在准备时间、手术时间和总手术室时间方面均有体现。实施该技术可使每天增加一台手术病例。
