Related Experiment Video
Updated: Jul 24, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Total Hip Arthroplasty Learning Curves Based on Approach for New Fellowship-trained Surgeons
James C Messina1, Justin A Magnuson, Christopher M Melnic
1From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Messina); Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA (Dr. Magnuson and Dr. Krueger); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Melnic); the Department of Orthopedic Surgery, Ascension Providence Rochester, Rochester, MI (Dr. Frisch); and Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso).
Introduction:
There is concern that the direct anterior (DA) approach is associated with a steeper learning curve than the posterolateral (PL) approach in total hip arthroplasty (THA). The purpose of this study was to investigate if the learning curve is similar for newly trained arthroplasty fellowship-trained surgeons using the DA and PL approaches.
Methods:
The first 100 primary THA cases of six DA and PL fellowship-trained arthroplasty surgeons were identified and divided into 50 case cohorts. Demographics, indications for surgery, and 90-day Hip Society standardized complications were collected. Variables were analyzed using independent sample t tests, chi-square tests, or Fisher exact tests.
Results:
In total, there were 600 patients, and no notable differences were observed in revision surgeries, surgical complications, and total complications between the DA and PL groups. Both groups had lower revision surgery rates, surgical complications, and total complications during their second 50 cases. Higher revision surgeries, and surgical and total complication rates were observed among all surgeons during the first 50 cases.
Discussion And Conclusion:
No differences were observed in the learning curve when comparing the DA and PL approach. With proper training, early-career surgeons can safely perform THA with similar complication rates regardless of the approach.
