Department of Orthopedics, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung City, 82445, Taiwan.
School of Medicine, College of Medicine, I-Shou University, No. 8, E-Da Road, Kaohsiung City, 82445, Taiwan.
Arch Orthop Trauma Surg. 2024 Feb;144(2):927-935. doi: 10.1007/s00402-023-05077-5. Epub 2023 Oct 6.
Most of the reported discussions about the learning curve for the direct anterior approach (DAA) in total hip arthroplasty (THA) have been by experienced surgeons. The study's aim was to describe the learning curve, short-term outcomes, complications, and adaptations to the DAA used in the first 100 THA cases experienced by a young surgeon who had received DAA training for trauma surgeries.
This retrospective study summarizes the first 100 consecutive cases experienced by a young surgeon who performed the unilateral DAA for THA between 2019 and 2021. Cumulative sum (CUSUM) analysis was performed to evaluate the learning curve on the basis of operative time and overall complications. The demographics data, short-term outcomes, and complications of the first 50 and second 50 cases were compared.
The CUSUM curve declined after 49 and 55 cases, measured by operative time and overall complications, respectively. The median operative time (104 vs. 80 min) and intraoperative fluoroscopic time (38 vs. 12 s) increased significantly in the first 50 cases compared with the times in the second 50 cases. Complications tended to occur in the first 50 cases (12% vs. 6%), and the overall rate was 9%. Major complications all occurred in the first 50 cases, with a rate of 4%. Only one case, which involved a complicated periprosthetic fracture around the stem that extended to the tip, required the intervention of a senior surgeon.
Even after receiving training on the DAA for trauma surgeries, the young surgeon experienced a steep learning curve and more complications in the first 50 cases. The DAA for THA is a technically demanding procedure and may require guidance from an experienced surgeon to manage unexpected complications.
大多数关于直接前入路（DAA）在全髋关节置换术（THA）中学习曲线的报道都是由经验丰富的外科医生进行的。本研究旨在描述一位接受过创伤手术 DAA 培训的年轻外科医生在进行第 100 例 THA 时的学习曲线、短期结果、并发症和对 DAA 的适应情况。
这是一项回顾性研究，总结了一位年轻外科医生在 2019 年至 2021 年间进行单侧 DAA 治疗 THA 的前 100 例连续病例。根据手术时间和总体并发症，采用累积和（CUSUM）分析评估学习曲线。比较了前 50 例和后 50 例的人口统计学数据、短期结果和并发症。
根据手术时间和总体并发症，CUSUM 曲线分别在第 49 例和第 55 例时下降。前 50 例的中位手术时间（104 分钟比 80 分钟）和术中透视时间（38 秒比 12 秒）显著增加。前 50 例并发症发生率较高（12%比 6%），总发生率为 9%。主要并发症均在前 50 例中发生，发生率为 4%。仅 1 例因位于柄周围的复杂假体周围骨折延伸至尖端而需要资深外科医生的干预。
即使接受过创伤手术的 DAA 培训，年轻外科医生在前 50 例中仍经历了陡峭的学习曲线和更多的并发症。DAA 用于 THA 是一项技术要求较高的手术，可能需要有经验的外科医生指导以处理意外并发症。
