Current Trends of Surgical Approach and Use of Enhancing Technology in Total Hip Arthroplasty: A Comparison of Early Career and More Experienced Surgeons Using the American Board of Orthopaedic Surgery Oral Examination and Recertification Data.

Background: Total hip arthroplasty (THA) has been among the most successful procedures in medicine, but the preferred approach and use of enhancing technologies are evolving. This study was conducted to define current THA practice (surgical approach and use of enhancing technologies) among early-career and more experienced surgeons. A secondary goal of this study was to identify differences in 6-month Patient-Reported Outcome Measurement Information System (PROMIS) pain interference or function scores and early complications.

Methods: In 2022 and 2023, 35,068 THAs were submitted to the American Board of Orthopaedic Surgery by candidates for the part II oral certification examination (14,993) and by Diplomates as part of the recertification process (20,075). The average patient age was 66 years, and 54% of patients were women. Baseline and 6-month PROMIS pain interference and function surveys were obtained from 2,019 patients in the Part II group. Postoperative complications were reported by the candidates or diplomates for all patients.

Results: Part II candidate surgical approach was direct anterior (DA) (69%), posterior (26%), direct lateral (2%), and other (2%). For recertification candidates, the surgical approach was DA (43%), posterior (43%), direct lateral (6%), and other (7%). Robotics or navigation was utilized in 18 and 15%, respectively. There were equivalent improvements in the PROMIS function in all groups. The surgeon-reported significant surgical complications were higher in part II candidates (8.4%) than in candidates undergoing recertification (2.7%, P < 0.001), with bone fracture the most common in each group (part II: 2.3%; recertification at 0.6%).

Conclusions: The part II candidates are more likely to utilize the DA approach compared to recertification candidates. The Part II candidates report higher rates of postoperative complications. However, there was no difference in the rate of surgeon-reported surgical complications or fractures based on surgical approach. Robotics and navigation are utilized in less than 20% of THA cases. The PROMs improved equally in all THA groups.