Study suggests the direct superior approach to THA has a short learning curve for surgeons
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For surgeons already trained in the posterior approach to total hip arthroplasty, recently published results have shown a “short” learning curve of fewer than 20 patients for the direct superior approach to total hip arthroplasty.
In a retrospective case series, researchers from the department of orthopedic surgery at Stanford University School of Medicine analyzed 40 direct superior (DS) THA procedures performed by a single surgeon. Researchers defined the learning curve as “the number of cases required for a surgeon to reach a stable rate of outcomes and complications,” they wrote in the study.
“These cases were divided into two groups of 20 and compared for intra- and postoperative complications, acetabular component positioning and Harris Hip Score at 90 days after surgery,” the researchers wrote. “As a control, the first 20 primary mini-posterior cases were analyzed as the baseline performance of the surgeon and the DS approach,” they added.
According to the study, there were no significant differences in Harris Hip Score, intraoperative complications, component positioning, dislocations, blood loss and length of stay between the groups. The only difference found was a decrease in operating time in the second group of procedures, suggesting a learning curve of fewer than 20 patients.
When comparing these outcomes with the posterior approach, researchers found patients who had surgery with the DS approach ambulated farther and had a shorter length of stay than patients who had the posterior approach.
“This study has provided insight into the DS-THA learning curve, especially for surgeons who already practice the posterior approach,” the researchers concluded. “The data could be especially pertinent as 90-day results and safety are becoming increasingly important in evaluating performance for bundled-payment models,” they wrote.
Perspective
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Per Kjaersgaard-Andersen, MD
The current study presents, in a retrospective set-up, the outcome of [two groups of] 20 patients operated with the DS approach to the hip joint, when performing primary THA. The authors also compared their outcomes with their earlier cases done through the mini-posterior approach. They observed no differences between their [two groups of] 20 cases, besides faster surgery in the latter group. Compared to their mini-posterior patients, the DS approach patients ambulated faster and had a shorter stay.
It is always complex to draw any valuable conclusions from retrospective studies. Even if the two approaches were studied in a randomized design, much bias would be there to make a true conclusion questionable.
However, the study shows that when experienced hip surgeons looks for a new and potential better approach, they are able to get good outcomes.
I’m afraid this study cannot be taken as a proof for other hip surgeons that they can obtain the same good results.
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