Transitioning from the Posterior Approach to the Direct Anterior Approach for Total Hip Arthroplasty.

Cameron M Metzger, Hassan Farooq, Jacqueline O Hur, John Hur
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引用次数: 1

Abstract

Purpose: Total hip arthroplasty (THA) using the direct anterior approach (DAA) is known to have a learning curve. The purpose of this study was to review cases where surgery was performed by an arthroplasty surgeon transitioning from the posterior approach (PA) to the DAA. We hypothesized similar complication rates and improvements in surgical duration over time.

Materials and methods: A review of 2,452 consecutive primary THAs was conducted. Surgical duration, length of stay (LOS), surgical complications, decrease in postoperative day (POD) 1 hemoglobin, transfusion rates, POD 0 and POD 1 pain scores, incision length, leg length discrepancy (LLD), and radiographic cup position were recorded.

Results: No differences in surgical duration were observed after the first 50 DAA cases. A shorter LOS was observed for the DAA, and statistical difference was appreciated after the first 100 DAA cases. There were no differences in periprosthetic fractures. A higher rate of infections and hip dislocations were observed with the PA. The PA showed an association with higher transfusion rates without significant difference in POD 1 decrease in hemoglobin over the first 100 DAA cases. Similar POD 0 and POD 1 pain scores with a smaller incision were observed for the first 100 DAA cases. The DAA cohort showed less variation in cup inclination, version, and LLD.

Conclusion: DAA is safe and non-inferior in terms of reduced LOS, smaller incision, and less variation in cup position. Fifty DAA cases was noted to be the learning curve required before no differences in duration between approaches were observed.

Abstract Image

Abstract Image

Abstract Image

全髋关节置换术从后路到直接前路的过渡。
目的:采用直接前路(DAA)的全髋关节置换术(THA)已知有一个学习曲线。本研究的目的是回顾由关节置换术医生从后路(PA)过渡到DAA进行手术的病例。我们假设随着时间的推移,并发症发生率相似,手术时间也有所改善。材料和方法:对2452例连续原发性tha进行回顾性分析。记录手术时间、住院时间(LOS)、手术并发症、术后日血红蛋白(POD) 1下降、输血率、POD 0和POD 1疼痛评分、切口长度、腿长差异(LLD)和x线杯位置。结果:前50例DAA术后手术时间无差异。观察到DAA的LOS较短,并且在前100例DAA病例后发现统计学差异。假体周围骨折无差异。PA有较高的感染率和髋关节脱位。在前100例DAA病例中,PA显示与较高的输血率相关,但血红蛋白POD 1下降无显著差异。前100例DAA患者的POD 0和POD 1疼痛评分相似,切口较小。DAA组在杯倾角、杯型和LLD上的变化较小。结论:DAA术在降低LOS、切口小、杯口位置变化少等方面是安全的、无缺陷的。在观察到两种方法的持续时间没有差异之前,注意到50例DAA需要学习曲线。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
2.90
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