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Archives of Orthopaedic and Trauma Surgery

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06-10-2023 | Periprosthetic Fracture | Hip Arthroplasty

First 100 total hip arthroplasties performed by a young surgeon using the direct anterior approach: learning curve and complications

Authors: Yen-Wei Li, Shang-Won Yu, Jih-Hsi Yeh, Ching-Hou Ma, Cheng-Yo Yen, Yuan-Kun Tu

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2024

Abstract

Introduction

Most of the reported discussions about the learning curve for the direct anterior approach (DAA) in total hip arthroplasty (THA) have been by experienced surgeons. The study’s aim was to describe the learning curve, short-term outcomes, complications, and adaptations to the DAA used in the first 100 THA cases experienced by a young surgeon who had received DAA training for trauma surgeries.

Materials and methods

This retrospective study summarizes the first 100 consecutive cases experienced by a young surgeon who performed the unilateral DAA for THA between 2019 and 2021. Cumulative sum (CUSUM) analysis was performed to evaluate the learning curve on the basis of operative time and overall complications. The demographics data, short-term outcomes, and complications of the first 50 and second 50 cases were compared.

Results

The CUSUM curve declined after 49 and 55 cases, measured by operative time and overall complications, respectively. The median operative time (104 vs. 80 min) and intraoperative fluoroscopic time (38 vs. 12 s) increased significantly in the first 50 cases compared with the times in the second 50 cases. Complications tended to occur in the first 50 cases (12% vs. 6%), and the overall rate was 9%. Major complications all occurred in the first 50 cases, with a rate of 4%. Only one case, which involved a complicated periprosthetic fracture around the stem that extended to the tip, required the intervention of a senior surgeon.

Conclusions

Even after receiving training on the DAA for trauma surgeries, the young surgeon experienced a steep learning curve and more complications in the first 50 cases. The DAA for THA is a technically demanding procedure and may require guidance from an experienced surgeon to manage unexpected complications.

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Title: First 100 total hip arthroplasties performed by a young surgeon using the direct anterior approach: learning curve and complications
Authors: Yen-Wei Li
Shang-Won Yu
Jih-Hsi Yeh
Ching-Hou Ma
Cheng-Yo Yen
Yuan-Kun Tu
Publication date: 06-10-2023
Publisher: Springer Berlin Heidelberg
Keywords: Periprosthetic Fracture
Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2024
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-05077-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

First 100 total hip arthroplasties performed by a young surgeon using the direct anterior approach: learning curve and complications

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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