title: Learning curve in tissue sparing total hip replacement: comparison between different approaches.
abstract: BACKGROUND
  The tissue sparing surgery (TSS) concept means not only smaller incisions but also less tissue disruption, allowing decreased blood loss and improved function. However, TSS techniques can result in more complications related to the learning curve. The aim of this study was to compare the learning curve of an experienced surgeon with different TSS approaches for total hip replacement (THR) from a clinical and surgical point of view, focussing especially on complications related to the use of different geometric stems.
  
  
  METHODS
  Sixty patients scheduled to be operated for a primary THR were enrolled in the study and were randomly assigned to surgery by one of three different TSS approaches: lateral with mini incision (group A), minimally invasive anterior (group B) and minimally invasive antero-lateral (group C). Results from the three TSS groups were compared with a control group of 149 patients (group D).
  
  
  RESULTS
  Our results reveal significantly reduced blood loss in the TSS groups compared with the control group, with no differences between the TSS groups. We found better early functional scores in the two minimally invasive groups (anterior and anterolateral), and a lower rate of complications with the antero-lateral TSS approach.
  
  
  CONCLUSIONS
  The antero-lateral TSS approach seems to be safer and less demanding than standard THR surgery, and is suitable for use with different stems.
authors.affiliation: II School of Medicine, Orthopaedic Unit, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: D'Arrigo
authors.forename: Attilio
authors.initials: A
authors.lastname: Speranza
authors.forename: Edoardo
authors.initials: E
authors.lastname: Monaco
authors.forename: Alessandro
authors.initials: A
authors.lastname: Carcangiu
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferretti