Abstract：
BACKGROUND: The direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) have advantages and disadvantages, but their physiologic burden to the surgeon has not been quantified. This study was conducted to determine whether differences exist in surgeon physiological stress and strain during DAA in comparison to PA.
METHODS: We evaluated a prospective cohort of 144 consecutive cases (67 DAA and 77 PA). There were 5, high-volume, fellowship-trained arthroplasty surgeons who wore a smart-vest that recorded cardiorespiratory data while performing primary THA DAA or PA. Heart rate (beats/minute), stress index (correlates with sympathetic activations), respiratory rate (respirations/minute), minute ventilation (L/min), and energy expenditure (calories) were recorded, along with patient body mass index and operative time. Continuous data was compared using t-tests or Mann Whitney U tests, and categorical data was compared with Chi-square or Fischer\'s exact tests.
RESULTS: There were no differences in patient characteristics. Compared to PA, performing THA via DAA had a significantly higher surgeon stress index (17.4 versus 12.4; P < .001), heart rate (101 versus 98.3; P = .007), minute ventilation (21.7 versus 18.7; P < .001), and energy expenditure per hour (349 versus 295; P < .001). However, DAA had a significantly shorter operative time (71.4 versus 82.1; P = .001).
CONCLUSIONS: Surgeons experience significantly higher physiological stress and strain when performing DAA compared to PA for primary THA. This study provides objective data on energy expenditure that can be factored into choice of approach, case order, and scheduling preferences, and provides insight into the work done by the surgeon.
METHODS: We evaluated a prospective cohort of 144 consecutive cases (67 DAA and 77 PA). There were 5, high-volume, fellowship-trained arthroplasty surgeons who wore a smart-vest that recorded cardiorespiratory data while performing primary THA DAA or PA. Heart rate (beats/minute), stress index (correlates with sympathetic activations), respiratory rate (respirations/minute), minute ventilation (L/min), and energy expenditure (calories) were recorded, along with patient body mass index and operative time. Continuous data was compared using t-tests or Mann Whitney U tests, and categorical data was compared with Chi-square or Fischer\'s exact tests.
RESULTS: There were no differences in patient characteristics. Compared to PA, performing THA via DAA had a significantly higher surgeon stress index (17.4 versus 12.4; P < .001), heart rate (101 versus 98.3; P = .007), minute ventilation (21.7 versus 18.7; P < .001), and energy expenditure per hour (349 versus 295; P < .001). However, DAA had a significantly shorter operative time (71.4 versus 82.1; P = .001).
CONCLUSIONS: Surgeons experience significantly higher physiological stress and strain when performing DAA compared to PA for primary THA. This study provides objective data on energy expenditure that can be factored into choice of approach, case order, and scheduling preferences, and provides insight into the work done by the surgeon.
摘要：
背景：全髋关节置换术（THA）的直接前入路（DAA）和后入路（PA）各有优缺点，但是他们对外科医生的生理负担尚未量化。进行这项研究是为了确定与PA相比，DAA期间外科医生的生理应力和应变是否存在差异。
方法：我们评估了144例连续病例（67DAA和77PA）的前瞻性队列。有五个，高容量，经过研究培训的关节成形术外科医生在进行原发性THADAA或PA时穿着记录心肺数据的智能背心。心率（心跳/分钟），压力指数(与交感神经激活相关)，呼吸频率（呼吸/分钟），分钟通风(升/分钟),记录能量消耗（卡路里），以及患者体重指数和手术时间。连续数据使用T检验或MannWhitneyU检验进行比较，并将分类数据与卡方或费舍尔精确检验进行比较。
结果：患者特征无差异。与PA相比，通过DAA进行THA的外科医生压力指数明显更高（17.4对12.4；P<0.001），心率（101对98.3；P=0.007），分钟通气量（21.7对18.7；P<0.001），和每小时的能量消耗（349对295；P<0.001）。然而,DAA的手术时间明显缩短（71.4对82.1；P=0.001）。
结论：进行DAA时，与进行原发性THA的PA相比，外科医生经历了显着更高的生理应激和应变。这项研究提供了关于能量消耗的客观数据，这些数据可以被考虑到方法的选择中，caseorder,和调度偏好，并提供外科医生所做工作的洞察力。
方法：我们评估了144例连续病例（67DAA和77PA）的前瞻性队列。有五个，高容量，经过研究培训的关节成形术外科医生在进行原发性THADAA或PA时穿着记录心肺数据的智能背心。心率（心跳/分钟），压力指数(与交感神经激活相关)，呼吸频率（呼吸/分钟），分钟通风(升/分钟),记录能量消耗（卡路里），以及患者体重指数和手术时间。连续数据使用T检验或MannWhitneyU检验进行比较，并将分类数据与卡方或费舍尔精确检验进行比较。
结果：患者特征无差异。与PA相比，通过DAA进行THA的外科医生压力指数明显更高（17.4对12.4；P<0.001），心率（101对98.3；P=0.007），分钟通气量（21.7对18.7；P<0.001），和每小时的能量消耗（349对295；P<0.001）。然而,DAA的手术时间明显缩短（71.4对82.1；P=0.001）。
结论：进行DAA时，与进行原发性THA的PA相比，外科医生经历了显着更高的生理应激和应变。这项研究提供了关于能量消耗的客观数据，这些数据可以被考虑到方法的选择中，caseorder,和调度偏好，并提供外科医生所做工作的洞察力。
