Introduction
The direct anterior hip approach has traditionally been associated with a steep learning curve. However, current education and technology learning tools may shorten this learning curve. The purpose of this study is to evaluate the efficacy of an extensive modern-day training protocol on the first 300 direct anterior hip replacement cases to a matched group of concurrent traditional mini-posterior approach cases.
Methods
Three-hundred consecutive direct anterior hip replacement cases in 2017 were compared to a consecutive cohort of mini-posterior approach cases performed during the same time period. All procedures were performed by a single surgeon. The anterior hip group was younger, 66 vs 70, and lower BMI 25 versus 29. Outcomes recorded included surgical time, ambulation distance day of surgery, pain with walking, pain at discharge.
Results
The anterior hip cases took longer than the posterior, 123 vs 85 minutes (p< 0.001). The anterior hip operating room time peaked after the initial three cases with the reverse surgeon visitation. Then the anterior group times decreased, with the last third of cases averaging 40 minutes faster than the first third. Hematocrit values were similar in the two groups both before and after surgery (p>0.09). The anterior hip group walked farther, 321 vs 187 feet the day of surgery, and with less pain, 2.3 vs 3.3 (p< 0.01). At the first postoperative visit, fewer assist devices were used with the anterior hip approach (p< 0.002).
Discussion
Modern training and education can minimize the occurrence of complications in this early group. In
particular, a reverse surgeon visitation reduces operating room time when learning is at its greatest, and surgeon
operating time continues to decrease with experience. Even during this learning curve, direct anterior hip replacement patients may ambulate greater distances, with less pain, with less assistance, compared to the surgeon's traditional approach.