Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
J Arthroplasty. 2024 Sep;39(9S2):S322-S326. doi: 10.1016/j.arth.2024.05.063. Epub 2024 May 25.
The direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) have advantages and disadvantages, but their physiologic burden to the surgeon has not been quantified. This study was conducted to determine whether differences exist in surgeon physiological stress and strain during DAA in comparison to PA.
We evaluated a prospective cohort of 144 consecutive cases (67 DAA and 77 PA). There were 5, high-volume, fellowship-trained arthroplasty surgeons who wore a smart-vest that recorded cardiorespiratory data while performing primary THA DAA or PA. Heart rate (beats/minute), stress index (correlates with sympathetic activations), respiratory rate (respirations/minute), minute ventilation (L/min), and energy expenditure (calories) were recorded, along with patient body mass index and operative time. Continuous data was compared using t-tests or Mann Whitney U tests, and categorical data was compared with Chi-square or Fischer's exact tests.
There were no differences in patient characteristics. Compared to PA, performing THA via DAA had a significantly higher surgeon stress index (17.4 versus 12.4; P < .001), heart rate (101 versus 98.3; P = .007), minute ventilation (21.7 versus 18.7; P < .001), and energy expenditure per hour (349 versus 295; P < .001). However, DAA had a significantly shorter operative time (71.4 versus 82.1; P = .001).
Surgeons experience significantly higher physiological stress and strain when performing DAA compared to PA for primary THA. This study provides objective data on energy expenditure that can be factored into choice of approach, case order, and scheduling preferences, and provides insight into the work done by the surgeon.
全髋关节置换术（THA）的直接前方入路（DAA）和后方入路（PA）各有优缺点，但它们对术者生理负担的影响尚未量化。本研究旨在比较 DAA 和 PA 时，确定术者生理应激和应变是否存在差异。
我们评估了 144 例连续病例（67 例 DAA 和 77 例 PA）的前瞻性队列。有 5 名高容量、接受过 fellowship培训的关节置换术者佩戴智能背心，在进行初次 THA DAA 或 PA 时记录心肺数据。记录心率（次/分钟）、应激指数（与交感神经激活相关）、呼吸频率（次/分钟）、分钟通气量（L/分钟）和能量消耗（卡路里），并记录患者体重指数和手术时间。使用 t 检验或曼-惠特尼 U 检验比较连续数据，使用卡方检验或 Fisher 确切概率法比较分类数据。
患者特征无差异。与 PA 相比，DAA 行 THA 的术者应激指数显著更高（17.4 比 12.4；P<.001）、心率更高（101 比 98.3；P=.007）、分钟通气量更高（21.7 比 18.7；P<.001）、每小时能量消耗更高（349 比 295；P<.001）。但 DAA 的手术时间明显更短（71.4 比 82.1；P=.001）。
与 PA 相比，术者在进行初次 THA 的 DAA 时经历明显更高的生理应激和应变。本研究提供了关于能量消耗的客观数据，可用于选择入路、手术顺序和安排偏好，并深入了解术者的工作。
