The learning curve of the direct anterior approach is 100 cases: an analysis based on 15,875 total hip arthroplasties in the Dutch Arthroplasty Register.

Autor: Peters RM; Department of Orthopedic Surgery, Medical Center Leeuwarden; Department of Orthopedic Surgery, University Medical Center Groningen. rinnepeters@gmail.com., Ten Have BLEF; Department of Orthopedic Surgery, Martini Hospital, Groningen., Rykov K; Department of Orthopedic Surgery, Martini Hospital, Groningen., Van Steenbergen L; Dutch Arthroplasty Register, 's Hertogenbosch., Putter H; Department of Medical Statistics and Bioinformatics Statistics, Leiden University Medical Center., Rutgers M; Department of Orthopedic Surgery, HAGA Hospital, The Hague., Vos S; Department of Orthopedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar., Van Steijnen B; Department of Orthopedic Surgery, Antonius ziekenhuis, Sneek., Poolman RW; Department of Orthopedic Surgery, OLVG, Amsterdam; Department of Orthopedic Surgery, Leiden University Medical Center., Vehmeijer SBW; Department of Orthopedic Surgery, Reinier de Graaf, Delft, the Netherlands., Zijlstra WP; Department of Orthopedic Surgery, Medical Center Leeuwarden.
Jazyk: angličtina
Zdroj: Acta orthopaedica [Acta Orthop] 2022 Sep 27; Vol. 93, pp. 775-782. Date of Electronic Publication: 2022 Sep 27.
DOI: 10.2340/17453674.2022.4802
Abstrakt: Background and Purpose: In the last decade, the direct anterior approach (DAA) for total hip arthroplasty (THA) has become more popular in the Netherlands. Therefore, we investigated the learning curve and survival rate of the DAA in primary THA, using data from the Dutch Arthroplasty Register (LROI).
Patients and Methods: We identified all patients who received a primary THA using the DAA in several high-volume centers in the Netherlands between 2007 and 2019 (n = 15,903). Procedures were ordered per surgeon, using date of operation. Using the procedure number, operations were divided into 6 groups based on the number of previous procedures per surgeon (first 25, 26-50, 51-100, 101-150, 151-200, > 200). Data from different surgeons in different hospitals was pooled together. Revision rates were calculated using a multilevel time-to-event analysis.
Results: Patients operated on in group 1-25 (hazard ratio [HR] 1.6; 95% CI 1.1-2.4) and 26-50 (HR 1.6; CI 1.1-2.5) had a higher risk for revision compared with patients operated on in group > 200 THAs. Between 50 and 100 procedures the revision risk was increased (HR 1.3; CI 0.9-1.9), albeit not statistically significant. From 100 procedures onwards the HR for revision was respectively 1.0 (CI 0.6-1.6) and 0.8 (CI 0.5-1.4) for patients in operation groups 101-150 and 151-200. Main reasons for revision were loosening of the stem (29%), periprosthetic infection (19%), and dislocation (16%).
Interpretation: We found a 64% increased risk of revision for patients undergoing THA using the DAA for the first 50 cases per surgeon. Between 50 and 100 cases, this risk was 30% increased, but not statistically significant. From 100 cases onwards, a steady state had been reached in revision rate. The learning curve for DAA therefore is around 100 cases.
Databáze: MEDLINE
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