Does Structured Postgraduate Training Affect the Learning Curve in Direct Anterior Total Hip Arthroplasty? A Single Surgeon’s First 200 Cases
| Autor: | Cesar Iturriaga, Sreevathsa Boraiah, Peter A. Gold, Luke J. Garbarino, Nipun Sodhi, Michael A. Mont |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Radiography Logistic regression Odds 03 medical and health sciences 0302 clinical medicine lcsh:Orthopedic surgery Statistical significance Medicine Orthopedics and Sports Medicine 030212 general & internal medicine Learning curve Original Research 030222 orthopedics business.industry Incidence (epidemiology) Fellowship training Odds ratio Perioperative Confidence interval Surgery lcsh:RD701-811 Direct anterior approach Total hip arthroplasty business |
| Zdroj: | Arthroplasty Today Arthroplasty Today, Vol 7, Iss, Pp 98-104 (2021) |
| ISSN: | 2352-3441 |
| DOI: | 10.1016/j.artd.2020.11.019 |
| Popis: | Background: The direct anterior approach (DAA) used for primary total hip arthroplasty has been shown to improve early postoperative outcomes, but prior studies have identified a marked learning curve for surgeons transitioning to this approach. However, these studies do not capture surgeons with postgraduate fellowship training in DAA. Therefore, the purpose of this study was to evaluate the learning curve by comparing perioperative outcomes for the first 100 to latter 100 cases and first 50 to final 50 cases. Methods: The first 200 consecutive primary total hip arthroplasties performed by a single surgeon were prospectively followed up for up to 2 years postoperatively. Data on demographic and perioperative factors, 90-day readmissions, and short- and long-term complications were collected. Radiographic outcomes included acetabular cup anteversion and abduction measurements. Logistic regressions were used to calculate odds ratios and confidence intervals for surgical time greater than 2 hours. Results: The first 100 and second 100 cases had significant differences in operative times (118.1 vs 110.4 minutes, P = .009), acetabular abduction (38.3 vs 35.5 degrees, P = .001) and anteversion (13.5 vs 15.1 degrees, P = .009), and incidence of neuropraxia (41 vs 9%, P < .001). Estimated blood loss, transfusions, discharge disposition, length of stay, readmission, and other complications had no statistical significance between the first and second 100 cases. The first 50 cases had higher odds of surgical time greater than 2 hours (odds ratio = 5.2, 95% confidence interval = 1.84-14.75, P = .002) than the final 50 cases. Conclusions: When compared with the existing literature, incorporation of DAA into fellowship training can lead to reduction in fractures and reoperation rates. |
| Databáze: | OpenAIRE |
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