Abstract：
BACKGROUND: Learning curves associated with independent practice and anterior approach total hip arthroplasty (AA-THA) has been associated with inferior outcome. This study compared outcome of junior, fellowship-trained, surgeons who perform THA through both anterior and posterior (PA) approach, with senior surgeons who perform either AA or PA, to determine whether: 1. Fellowship training and selective practice allows for safe introduction of AA into practice; and 2. Whether selective approach-use influences outcome.
METHODS: This is a prospective, consecutive study comparing the first 800 THAs of two junior, dual-approach, surgeons (AA/PA: 455/345), with 400 THAs cases of two senior, single-approach, surgeons (AA/PA: 200/200), between 2018 and 2020. Most patients were female (54.4%), mean age was 65 years-old (range 19-96) and mean BMI was 29 kg/m2 (range 16-66). Outcome included radiologic measurements (inclination/anteversion and leg-length), complication- and revision rates, and patient-reported outcomes including Oxford Hip Score (OHS).
RESULTS: At 3.1 years (range 2.0-6.8) follow-up, there were 43 complications (3.6%), including 27 re-operations (2.3%); with no difference between junior and senior surgeons for AA-THA (Junior: 8/455 vs. Senior: 3/200; p = 0.355) or PA-THA (Junior: 11/345 vs. Senior: 5/200; p = 0.400). Amongst juniors, there was no difference in complications (AA:8/455 vs. PA:11/345; p = 0.140) and in ΔOHS (AA:20.5 ± 7.7 vs. PA:20.5 ± 8.0; p = 0.581) between approaches.
CONCLUSIONS: Contemporary training and selective approach-use minimizes the learning curve, allowing junior staff to have equivalent outcome to established, senior surgeons in both AA and PA. We would advocate for selective approach use amongst junior arthroplasty surgeons when introducing the AA into independent practice.
METHODS: This is a prospective, consecutive study comparing the first 800 THAs of two junior, dual-approach, surgeons (AA/PA: 455/345), with 400 THAs cases of two senior, single-approach, surgeons (AA/PA: 200/200), between 2018 and 2020. Most patients were female (54.4%), mean age was 65 years-old (range 19-96) and mean BMI was 29 kg/m2 (range 16-66). Outcome included radiologic measurements (inclination/anteversion and leg-length), complication- and revision rates, and patient-reported outcomes including Oxford Hip Score (OHS).
RESULTS: At 3.1 years (range 2.0-6.8) follow-up, there were 43 complications (3.6%), including 27 re-operations (2.3%); with no difference between junior and senior surgeons for AA-THA (Junior: 8/455 vs. Senior: 3/200; p = 0.355) or PA-THA (Junior: 11/345 vs. Senior: 5/200; p = 0.400). Amongst juniors, there was no difference in complications (AA:8/455 vs. PA:11/345; p = 0.140) and in ΔOHS (AA:20.5 ± 7.7 vs. PA:20.5 ± 8.0; p = 0.581) between approaches.
CONCLUSIONS: Contemporary training and selective approach-use minimizes the learning curve, allowing junior staff to have equivalent outcome to established, senior surgeons in both AA and PA. We would advocate for selective approach use amongst junior arthroplasty surgeons when introducing the AA into independent practice.
摘要：
背景：与独立实践和前路全髋关节置换术（AA-THA）相关的学习曲线与较差的结果相关。这项研究比较了初中的结果，奖学金培训，通过前后（PA）入路进行THA的外科医生，与执行AA或PA的高级外科医生一起，确定是否：1.奖学金培训和选择性实践允许将AA安全引入实践;和2。选择性方法使用是否会影响结果。
方法：这是一个前瞻性的，连续研究比较了两个大三学生的前800个THA，双重方法，外科医生（AA/PA：455/345），有400个THA的两个大四学生，单一方法，外科医生（AA/PA：200/200），在2018年至2020年之间。大多数患者为女性（54.4%），平均年龄为65岁(范围19-96),平均BMI为29kg/m2(范围16-66).结果包括放射学测量（倾斜度/前倾和腿长度），复杂性和修订率，和患者报告的结局，包括牛津髋关节评分（OHS）。
结果：在3.1年（范围2.0-6.8）随访时，有43例并发症(3.6%)，包括27次再次手术（2.3％）；AA-THA的初级和高级外科医生之间没有差异（初级：8/455vs.高级：3/200；p=0.355）或PA-THA（初级：11/345vs.高级：5/200；p=0.400）。在大三学生中，并发症没有差异(AA：8/455vs.PA：11/345；p=0.140）和ΔOHS（AA：20.5±7.7vs.PA：20.5±8.0；p=0.581）之间的方法。
结论：当代培训和选择性方法的使用可最大程度地减少学习曲线，让初级员工有与既定员工相当的结果，AA和PA的高级外科医生。在将AA引入独立实践时，我们主张在初级关节成形术外科医生中使用选择性方法。
方法：这是一个前瞻性的，连续研究比较了两个大三学生的前800个THA，双重方法，外科医生（AA/PA：455/345），有400个THA的两个大四学生，单一方法，外科医生（AA/PA：200/200），在2018年至2020年之间。大多数患者为女性（54.4%），平均年龄为65岁(范围19-96),平均BMI为29kg/m2(范围16-66).结果包括放射学测量（倾斜度/前倾和腿长度），复杂性和修订率，和患者报告的结局，包括牛津髋关节评分（OHS）。
结果：在3.1年（范围2.0-6.8）随访时，有43例并发症(3.6%)，包括27次再次手术（2.3％）；AA-THA的初级和高级外科医生之间没有差异（初级：8/455vs.高级：3/200；p=0.355）或PA-THA（初级：11/345vs.高级：5/200；p=0.400）。在大三学生中，并发症没有差异(AA：8/455vs.PA：11/345；p=0.140）和ΔOHS（AA：20.5±7.7vs.PA：20.5±8.0；p=0.581）之间的方法。
结论：当代培训和选择性方法的使用可最大程度地减少学习曲线，让初级员工有与既定员工相当的结果，AA和PA的高级外科医生。在将AA引入独立实践时，我们主张在初级关节成形术外科医生中使用选择性方法。
