Ann Orthop Musculoskelet Disord | Volume 4, Issue 1 | Research Article | Open Access
Rajrishi S1, Joly DA1, Mahdavi S1*, Sophie (Ghashang) P2, Chen G3, Khong H4, Faris P5 and Matta J6
1Department of Orthopedic Surgery, University of Calgary, Canada
2Department of Orthopedic Surgery, Alberta Bone and Joint Health Institute, Canada
3Department of Community Health Sciences, University of Calgary, Canada
4Alberta Bone and Joint Health Institute, Canada
5Research Facilitation Analytics, University of Calgary, Canada
6Department of Orthopedic Surgery, Hip and Pelvis Institute St John’s, USA
*Correspondance to: Saboura Mahdavi
Fulltext PDFBackground: Multiple approaches to Total Hip Arthroplasty (THA) exist including but not limited to the Lateral Approach (LA), Posterior Approach (PA), and Anterior Approach (AA). Interest within the Anterior Approach (AA) to is increasing but safety and whether benefits exist during the learning curve are constantly questioned. Purpose: The purpose of this study was to compare outcomes in primary total hip arthroplasties performed through AA during the learning curve compared to LA and PA. Methods: Using a retrospective, multi-center matched study design and exceeding the necessary sample size calculation, 115 patients that underwent AA were matched to 230 LA and 230 PA. Patients were matched for age (p=0.99), gender (p=0.999), medical comorbidities (p=0.410), and BMI (p=0.983). Outcomes including significant medical and mechanical events, length of stay, discharge destination, 30-day readmission rate, transfusion rates, surgical time and narcotic use were analyzed. Results: A 30-day readmission rate (p=0.778) and medical events (p=0.225) were not statistically significant. The average surgical time for the AA was 17.99 min (p<0.001) longer than the average combined time for LA and PA. Statistically significant fewer mechanical complications including dislocation (p=0.011), LOS (p<0.001), more patients discharged directly home (p=0.016) and fewer blood transfusion (p=0.002) with AA compared to LA and PA. Average per hour morphine equivalent use of the first three post-operative days was significantly less for AA when compared to LA (p=0.01) and PA (p=0.02). Conclusion: As expected, the AA has an increase in surgical time compared to other approaches during the learning curve without a change in the number of cases per day. However, the AA has fewer mechanical complications, shorter acute LOS and total LOS, has more patients being discharged directly home and fewer blood transfusions. Patients undergoing AA also have significant less pain and therefore require less post-operative narcotics. Overall, we found the learning curve of the anterior approach to be safe.
Rajrishi S, Joly DA, Mahdavi S, Sophie (Ghashang) P, Chen G, Khong H, et al. Differences in Outcomes during the Learning Curve of the Anterior Approach Compared to Posterior and Lateral Approaches of Total Hip Arthroplasty: A Retrospective Matched Cohort Study. Ann Orthop Musculoskelet Disord. 2021; 4(1): 1025.