Learning curve of direct anterior total hip arthroplasty : a single surgeon experience

Abstract

There is strong evidence that the minimal invasive direct anterior approach for primary total hip arthroplasty (DAA-THA) is responsible for a faster return to function and daily activity and an enhanced short-term recovery and rehabilitation in comparison with other total hip approaches. The effect of the learning curve on patient safety and surgical outcome after commencing with the direct anterior surgical approach remains unclear. This single surgeon study presents the postoperative results of the initial 200 cases after implementing the direct anterior approach (DAA) compared with the initial 200 cases after implementing a 24 hours time- based fast-track program using identical technique by the same surgeon. The effect of the learning curve has been described in operative parameters, overall complications and radiological component placement. The complication rate of the initial 100 cases after commencing with the direct anterior operation technique was high and declined thereafter. After implementing a new time-based fast-tack program with identical DAA-THA technique we found from the outset unchanged low complication and revision rates. The learning phase in performing the direct anterior hip replacement is rather long but the incidence of complications decreases with greater surgeon experience and does not increase after implementing a new time-based fast-track program. In this study the learning curve could be defined over 100 cases.