Sage Journals: Discover world-class research

Abstract

Background:

Recently, surgeons introduced a minimally invasive modification on the classic posterolateral approach (PLA) in total hip arthroplasty (THA): the direct superior approach (DSA). We investigated the association between surgeon’s experience and the risk of early revision of the DSA in primary THA, using data from the Dutch Arthroplasty Register (LROI).

Methods:

We retrieved all primary THAs performed using the DSA in 4 hospitals between 2016 and 2022 (n = 1551). Procedures were sorted in 5 groups using the date of operation and number of previous procedures per surgeon: 1–25; 26–50; 51–75; 76–100; >100. Subsequently, data from different surgeons were pooled together and the risk of revision was calculated via a multilevel time-to-event analysis.

Results:

The overall revision rate was 1.5% after a mean follow-up of 2 years. Patients from the 1–25 group had comparable risks of revision compared to patients in the >100 group (hazard ratio [HR] 1.0 [CI, 0.3–3.2]). The risk for patients in groups 26–50, 51–75 and 75–100 was also not statistically different from the >100 group (resp. HR 1.5 [CI, 0.5–5.0], 1.8 [CI, 0.5–6.4] and 0.5 [CI, 0.1–4.0]). Main reasons of revision were dislocation (0.5%) and infection (0.4%).

Conclusions:

We did not identify an association between the surgeon’s experience and the early risk of revision for the DSA in primary THA in the Netherlands. The DSA seems safe in the early adoption phases with a low risk of revision due to dislocation and revision for all other causes.

Keywords

Direct superior approach surgical experience total hip arthroplasty

Get full access to this article

View all access options for this article.

References

Petis

Howard

Lanting

, et al. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg 2015; 58: 128–139.

Higgins

Barlow

Heagerty

, et al Anterior vs.Posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty 2015; 30: 419–434.

Huerfano

Bautista

Huerfano

, et al. Use of surgical approach is not associated with instability after primary total hip arthroplasty: a meta-analysis comparing direct anterior and posterolateral approaches. J Am Acad Orthop Surg 2021; 29: e1126–e1140.

Hoskins

Bingham

Lorimer

, et al. Early rate of revision of total hip arthroplasty related to surgical approach: an analysis of 122,345 primary total hip arthroplasties. J Bone Joint Surg Am 2020; 102: 1874–1882.

LROI. Annual report 2022. Trend in surgical approach for performing a primary total hip arthroplasty in the Netherlands in 2012–2021, https://lroi-rapportage.gopublic.Work/app/uploads/2022/11/PDF-LROI-annual-report-2022.pdf (2022, accessed 26 January 2023).

Somford

Hoornenborg

Wiegerinck

, et al. Eponymous hip joint approaches. Arch Orthop Trauma Surg 2016; 136: 1007–1014.

Zijlstra

De Hartog

Van Steenbergen

, et al. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty. Acta Orthop 2017; 88: 395–401.

Peters

Ten Have

BLEF

Rykov

, et al. The learning curve of the direct anterior approach is 100 cases: an analysis based on 15,875 total hip arthroplasties in the Dutch Arthroplasty Register. Acta Orthop 2022; 93: 775–782.

Nairn

Gyemi

Gouveia

, et al. The learning curve for the direct anterior total hip arthroplasty: a systematic review. Int Orthop 2021; 45: 1971–1982.

10.

Maratt

Gagnier

Butler

, et al. No difference in dislocation seen in anterior vs posterior approach total hip arthroplasty. J Arthroplasty 2016; 31(Suppl.): 127–130.

11.

Van Dooren

Peters

Ettema

, et al. Revision risk by using the direct superior approach (DSA) for total hip arthroplasty compared with postero-lateral approach: early nationwide results from the Dutch Arthroplasty Register (LROI). Acta Orthop 2023; 94: 158–164.

12.

Barrett

Ezzibdeh

Horst

, et al. Direct superior approach to the hip for total hip arthroplasty. JBJS Essent Surg Tech 2019; 9: e17.

13.

von Elm

Altman

Egger

, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 2014; 12: 1495–1499.

14.

LROI. Wat is de LROI? https://www.lroi.nl/over-de-lroi/wat-is-de-lroi (accessed 26 January 2023).

15.

van Steenbergen

Denissen

Spooren

, et al. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register. Acta Orthop 2015; 86: 498–505.

16.

LROI report. Annual report Dutch arthroplasty register; 2022. Data Quality. Validity. Overview of validity by variable for each joint of hip, knee, ankle, shoulder, wrist and finger arthroplaties registered in the Netherlands in 2021. https://www.lroi-report.nl/app/uploads/2022/11/PDF-LROI-annual-report-2022.pdf.

17.

Vektis. Vektis business intelligence centrum voor de zorg, www.vektis.nl (accessed 26 January 2023).

18.

Lacny

Wilson

Clement

, et al. Kaplan-Meier survival analysis overestimates the risk of revision arthroplasty: a meta-analysis. Clin Orthop Relat Res 2015; 473: 3431–3442.

19.

Balan

Putter

A tutorial on frailty models. Stat Methods Med Res 2020; 29: 3424–3454.

20.

Yau

KK.

Multilevel models for survival analysis with random effects. Biometrics 2001; 57: 96–102.

21.

Duijnisveld

van den Hout

JAAM

Wagenmakers

, et al. No learning curve of the direct superior approach in total hip arthroplasty. Orthop Surg 2020; 12: 852–860.

22.

Ezzibdeh

Barrett

Arora

, et al. Learning curve for the direct superior approach to total hip arthroplasty. Orthopedics 2020; 43: e237–e243.

23.

Leonard

Ohly

NE.

Direct superior approach for total hip arthroplasty. Bone Joint J 2021; 103-B: 500–506.

24.

Callanan

Jarrett

Bragdon

, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 2011; 469: 319–329.

25.

Watanabe

Uematsu

Tabata

, et al. Computer navigated total hip arthroplasty via the direct superior approach: a retrospective study of the first 30 consecutive cases. Research Square. Epub preprint 15 July 2021. DOI: 10.21203/rs.3.rs-665843/v1.

26.

Kayani

Konan

Chandramohan

, et al. The direct superior approach in total hip arthroplasty. Br J Hosp Med (Lond) 2019; 80: 320–324.

27.

Korth

MJS

Ezzibdeh

Arora

, et al. Excellent clinical and radiographic outcomes with direct superior total hip arthroplasty with a minimum of two-year follow up. Surg Technol Int 2021; 37: 342–346.

28.

LROI. Annual report 2022. Patient characteristics of all patients with a registered primary total hip arthroplasty by diagnosis in the Netherlands in 2021, https://lroi-rapportage.gopublic.Work/app/uploads/2022/11/PDF-LROI-annual-report-2022.pdf (2022, accessed 26 January 2023).

29.

Peters

van Steenbergen

Stewart

, et al. Patient characteristics influence revision rate of total hip arthroplasty: American Society of Anesthesiologists score and body mass index were the strongest predictors for short-term revision after primary total hip arthroplasty. J Arthroplasty 2020; 35: 188–192.e2.

30.

Tsiridis

Kenanidis

Potoupnis

, et al. Direct superior approach with standard instrumentation for total hip arthroplasty: safety and efficacy in a prospective 200-case series. Hip Int 2020; 30: 552–558.

31.

van Steenbergen

de Reus

Hannink

, et al. Femoral head size and surgical approach affect dislocation and overall revision rates in total hip arthroplasty: up to 9-year follow-up data of 269,280 procedures in the Dutch Arthroplasty Register (LROI). Hip Int 2023; 33: 1056–1062.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB

0.01 MB

Low revision rate throughout the adoption of the direct superior approach in primary total hip arthroplasty: an analysis based on 1551 total hip arthroplasties from the Dutch Arthroplasty Register

Abstract

Background:

Methods:

Results:

Conclusions:

Keywords

Get full access to this article

References

Supplementary Material