Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba city, Chiba, Japan.
Department of Orthopedic Surgery, St. Marianna University, Kawasaki city, Kanagawa, Japan.
J Arthroplasty. 2024 Nov;39(11):2774-2779. doi: 10.1016/j.arth.2024.04.080. Epub 2024 May 4.
The direct anterior approach (DAA) for total hip arthroplasty (THA) is attracting attention as a minimally invasive surgery, but the learning curve to master this approach is a concern, and its effect on long-term results is unknown. The purpose of this prospective cohort study was to clarify how the learning curve affects the 5-year results of DAA THA with a traction table.
Of 402 THA cases using DAA with a mobile traction table and fluoroscopy, 249 cases composed of the first 50 cases for each surgeon were assessed during a learning curve, and 153 cases were evaluated after more than 50 cases of experience.
The 5-year-implant survival rate was 99.2% both during and after the learning curve. The 2-year complication rate in the learning curve group was 8.9 versus 5.9%, which was not statistically significant. The 2-to-5-year complication rates also did not differ between the cohorts (0 versus 0.7%). Both groups demonstrated decreased complication rates when comparing 2-year complications to 2-to-5-year complications. Clinical scores significantly improved by 2 years and were maintained at 5 years in both groups. The cup safe-zone success rates were 96.4% during the learning curve and 98.7% after the learning curve. The stem safe-zone success rates were 97.2% during the learning curve and 96.1% after the learning curve. Surgical time was approximately 20 minutes shorter after the first 50 cases than during the learning curve (70.8 versus 90.6 minutes, P = .001). Intraoperative blood loss was significantly less after the learning curve than during the learning curve.
This study implies that the learning curve affects perioperative results such as surgical time and intraoperative blood loss, but has little effect on short-term results up to 2 years after surgery and no effect on mid-term results from 2 to 5 years after surgery.
直接前方入路（DAA）全髋关节置换术（THA）作为一种微创手术受到关注，但掌握这种入路的学习曲线是一个关注点，其对长期结果的影响尚不清楚。本前瞻性队列研究的目的是阐明在使用移动牵引台和透视的 DAA 中，学习曲线如何影响 DAA-THA 的 5 年结果。
在 402 例使用 DAA 与移动牵引台和透视的 THA 中，评估了前 50 例的每个术者的 249 例，评估了 50 例以上经验的 153 例。
学习曲线期间和之后，5 年植入物存活率均为 99.2%。学习曲线组的 2 年并发症率为 8.9%比 5.9%，无统计学意义。两组的 2 至 5 年并发症率也无差异（0 比 0.7%）。两组均显示出从 2 年并发症到 2 至 5 年并发症的并发症发生率降低。两组的临床评分均在 2 年内显著改善，并在 5 年内保持不变。在学习曲线期间，杯安全区成功率为 96.4%，在学习曲线之后为 98.7%。在学习曲线期间，干骺端安全区成功率为 97.2%，在学习曲线之后为 96.1%。与学习曲线期间相比，第 50 例后手术时间缩短约 20 分钟（70.8 与 90.6 分钟，P =.001）。与学习曲线期间相比，学习曲线后术中出血量明显减少。
本研究表明，学习曲线影响手术时间和术中出血量等围手术期结果，但对术后 2 年内的短期结果影响不大，对术后 2 至 5 年的中期结果没有影响。
