TY - JOUR
T1 - Advantages of an Anterior-Based Muscle-Sparing Approach in Transitioning From a Posterior Approach for Total Hip Arthroplasty
T2 - Minimizing the Learning Curve
AU - Kagan, Ryland P.
AU - Greber, Eric M.
AU - Richards, Stephen M.
AU - Erickson, Jill A.
AU - Anderson, Mike B.
AU - Peters, Christopher L.
N1 - Publisher Copyright:
© 2019
PY - 2019/12
Y1 - 2019/12
N2 - Background: Enthusiasm for anterior-based approaches for total hip arthroplasty (THA) continues to increase but there is concern for increased complications during the learning curve period associated. This study aimed to investigate if there was a difference in perioperative variables, intraoperative and immediate postoperative complications, or patient-reported outcomes when transitioning from a mini-posterior approach (mPA) to an anterior-based muscle-sparing (ABMS) approach for THA. Methods: Retrospective cohort study on the first 100 primary THA cases (n = 96 patients) of the senior author (August 2016 to August 2017) using the ABMS approach. These cases were compared to primary THA cases done the year prior (July 2015 to July 2016, n = 91 cases in 89 patients) using an mPA. Data were extracted and analyzed via gamma regression with robust standard errors and using generalized estimating equation regression. Results: We found no difference in the estimated blood loss (P =.452) and surgical time (P =.564) between the cohorts. The ABMS cases had a slightly shorter length of stay (P =.001) with an adjusted mean length of stay of 1.53 days (95% confidence interval 1.4-1.6) compared to 1.85 days (95% confidence interval 1.8-1.9) in the mPA cases. There was no difference in the frequency of immediate postoperative complications (all, P >.05). There was no difference in the adjusted mean change in patient-reported outcomes (all P >.05). In the ABMS group, there was no difference in surgical time or physical function computerized adaptive test between the first 20 cases (reference) and each subsequent group of 20 cases (all P >.05). Conclusion: This study demonstrates no associated learning curve for an experienced senior surgeon when switching routine THA approach from mPA to ABMS. We advise careful interpretation of our results, as they may not apply to all surgeons and practices. Level of Evidence: Level III Therapeutic Study: retrospective comparative study.
AB - Background: Enthusiasm for anterior-based approaches for total hip arthroplasty (THA) continues to increase but there is concern for increased complications during the learning curve period associated. This study aimed to investigate if there was a difference in perioperative variables, intraoperative and immediate postoperative complications, or patient-reported outcomes when transitioning from a mini-posterior approach (mPA) to an anterior-based muscle-sparing (ABMS) approach for THA. Methods: Retrospective cohort study on the first 100 primary THA cases (n = 96 patients) of the senior author (August 2016 to August 2017) using the ABMS approach. These cases were compared to primary THA cases done the year prior (July 2015 to July 2016, n = 91 cases in 89 patients) using an mPA. Data were extracted and analyzed via gamma regression with robust standard errors and using generalized estimating equation regression. Results: We found no difference in the estimated blood loss (P =.452) and surgical time (P =.564) between the cohorts. The ABMS cases had a slightly shorter length of stay (P =.001) with an adjusted mean length of stay of 1.53 days (95% confidence interval 1.4-1.6) compared to 1.85 days (95% confidence interval 1.8-1.9) in the mPA cases. There was no difference in the frequency of immediate postoperative complications (all, P >.05). There was no difference in the adjusted mean change in patient-reported outcomes (all P >.05). In the ABMS group, there was no difference in surgical time or physical function computerized adaptive test between the first 20 cases (reference) and each subsequent group of 20 cases (all P >.05). Conclusion: This study demonstrates no associated learning curve for an experienced senior surgeon when switching routine THA approach from mPA to ABMS. We advise careful interpretation of our results, as they may not apply to all surgeons and practices. Level of Evidence: Level III Therapeutic Study: retrospective comparative study.
KW - anterior-based muscle-sparing approach
KW - complications
KW - outcomes
KW - patient-reported outcomes
KW - total hip arthroplasty
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U2 - 10.1016/j.arth.2019.07.009
DO - 10.1016/j.arth.2019.07.009
M3 - Article
C2 - 31383494
AN - SCOPUS:85075090041
SN - 0883-5403
VL - 34
SP - 2962
EP - 2967
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 12
ER -