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Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on...

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Autores principales: Foissey, Constant, Fauvernier, Mathieu, Fary, Cam, Servien, Elvire, Lustig, Sébastien, Batailler, Cécile
Formato: Online Artículo Texto
Lenguaje:English
Publicado: EDP Sciences 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273835/
https://www.ncbi.nlm.nih.gov/pubmed/32500856
http://dx.doi.org/10.1051/sicotj/2020015
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author Foissey, Constant
Fauvernier, Mathieu
Fary, Cam
Servien, Elvire
Lustig, Sébastien
Batailler, Cécile
author_facet Foissey, Constant
Fauvernier, Mathieu
Fary, Cam
Servien, Elvire
Lustig, Sébastien
Batailler, Cécile
author_sort Foissey, Constant
collection PubMed
description Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.
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spelling pubmed-72738352020-06-16 Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve? Foissey, Constant Fauvernier, Mathieu Fary, Cam Servien, Elvire Lustig, Sébastien Batailler, Cécile SICOT J Original Article Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV. EDP Sciences 2020-06-03 /pmc/articles/PMC7273835/ /pubmed/32500856 http://dx.doi.org/10.1051/sicotj/2020015 Text en © The Authors, published by EDP Sciences, 2020 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Foissey, Constant
Fauvernier, Mathieu
Fary, Cam
Servien, Elvire
Lustig, Sébastien
Batailler, Cécile
Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?
title Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?
title_full Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?
title_fullStr Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?
title_full_unstemmed Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?
title_short Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?
title_sort total hip arthroplasty performed by direct anterior approach – does experience influence the learning curve?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273835/
https://www.ncbi.nlm.nih.gov/pubmed/32500856
http://dx.doi.org/10.1051/sicotj/2020015
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