title: Transitioning to the Direct Anterior Approach in Total Hip Arthroplasty: Is It Safe in the Current Health Care Climate?
abstract: The direct anterior approach for total hip arthroplasty has recently gained interest for its quicker short-term recovery despite concerns about increased complications and operative time, especially during the steep learning curve period. The primary goal of this study was to determine if the transition from a posterior approach to a direct anterior approach for total hip arthroplasty can be achieved without harming patient safety.
  
  
  
  This is a retrospective cohort single-surgeon study of consecutive primary total hip arthroplasties performed over a transition period from posterior to direct anterior (DA) approach.
  
  
  
  A total of 412 patients (211 anterior, 201 posterior) were included with no significant demographic differences between cohorts. There were no significant differences between the DA and posterior group in 30-day readmission rates (2.84% vs 2.49%, P = .823), 90-day readmission rates (4.27 vs 5.97, P = .432), complication rate (6.16% vs 3.48%, P = .206), or revision rate (1.90% vs 2.99%, P = .535). The DA group had a significantly lower percentage of cases outside the goal abduction angle range (35°-50°) than the posterior group (9.52%, n = 20 vs 19.6%, n = 39, P < .01). The number of cases outside the goal leg length discrepancy range (±10 mm) was not significantly different (P = .846) between the DA (12.9%) and posterior (13.6%) groups.
  
  
  
  This single-surgeon study demonstrates that the DA approach can be transitioned to safely with no significant increase in complications or readmissions over a high-volume experienced surgeon's first 200 cases. Furthermore, our results endorse the consistency of the DA approach during the learning curve period in regard to component positioning compared to posterior approach.
authors.affiliation: Department of Orthopaedic Surgery (MC 844), University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Schwartz
authors.affiliation: Department of Orthopaedic Surgery (MC 3079), University of Chicago, Chicago, Illinois.
authors.forename: Zachary W
authors.initials: ZW
authors.lastname: Sisko
authors.affiliation: Department of Orthopaedic Surgery (MC 844), University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Mayekar
authors.affiliation: Department of Orthopaedic Surgery (MC 844), University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Olivia J
authors.initials: OJ
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Surgery (MC 844), University of Illinois at Chicago, Chicago, Illinois; Illinois Bone and Joint Institute, Morton Grove, Illinois.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Gordon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D056888:Patient Positioning; D010359:Patient Readmission; D061214:Patient Safety / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D066231:Surgeons / Q000191:economics
keywords: complications; direct anterior approach; learning curve; posterior approach; total hip arthroplasty