The Journal of Hip Surgery 2019; 03(01): 041-047
DOI: 10.1055/s-0039-1678740
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Learning Curve of the Direct Anterior Approach without Traction Table in Total Hip Replacement: Using the LC-CUSUM Method

Koen Steentjes
1  Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
,
Stefan R. Beekhuizen
1  Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
,
Wouter Eilander
1  Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
,
Wendy Meesters
2  Harting-Bank, The Hague, The Netherlands
,
Paulien M. van Kampen
3  Department of Orthopaedic Surgery, Bergman Clinics, Rijswijk, The Netherlands
,
Joris C.T. van der Lugt
1  Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
› Author Affiliations
Further Information

Publication History

07 February 2018

26 October 2018

Publication Date:
15 February 2019 (online)

Abstract

The surgical approach for total hip replacement (THR) depends on surgeon preference or the preference and experience of the surgeon with a specific approach. The aim of this study was to analyze the learning curve of the direct anterior approach (DAA) using the cumulative summation test for learning curve (LC-CUSUM). A retrospectively collected database of 400 THRs using the DAA (January 2010–September 2014) at a single center by a single surgeon. The learning curve was analyzed by determining the duration of surgery, blood loss, and number of complications. All 400 primary THRs were reviewed. Based on the LC-CUSUM, duration of surgery, and surgical failure, the learning curve plateau was achieved after the 19th surgery and the curve follows a substantially negative trend. The average duration of surgery changed significantly for the first hundred (78 minutes) to the last hundred (61 minutes). A significant decrease in blood loss was observed as well. A total of 17 (4.25%) complications occurred, with reduction of the complication rate as surgeons' experience increases. The authors' study did not show the long learning curve as previously described in the literature. The number of complications was small, and there was a significant decrease in duration of surgery, blood loss, and number of complications as surgeon's experience increases. The authors suggest that the educational environment of a teaching hospital, combined with the use of the DAA as a standard approach for all primary THRs and supervision of experienced surgeons, contribute to the favorable learning curve with a low complication rate.