title: Orthopaedic trauma surgeons and direct anterior total hip arthroplasty: evaluation of learning curve at a level I academic institution.
abstract: BACKGROUND
  Interest in the direct anterior approach for total hip arthroplasty has increased over recent years; however, the potential for substantial complications exists, especially during the surgeon's learning curve. We evaluated the change in various metrics to help identify a single surgeon's learning curve. Additionally, we examined whether the learning curve was different for primarily arthroplasty versus trauma-trained surgeons.
  
  
  METHODS
  We reported outcomes from the first 50 total hip arthroplasties performed through a direct anterior approach by a trauma fellowship-trained orthopaedic surgeon. Intraoperative and post-operative clinical outcomes were evaluated, including length of procedure, estimated blood loss, length of hospitalization, disposition to home versus care facility, need for blood transfusion, and complications. Previous reported learning curve outcomes were analysed with a comparison between those who are primarily arthroplasty specialists versus those who include hip arthroplasty as only a portion of their practice.
  
  
  RESULTS
  A significant difference in surgical time from 135 to 113 min was observed between the first 25 cases and the last 25. Estimated blood loss (EBL) and lateral femoral cutaneous nerve injury rates decreased but not to a significant degree. Among reported learning curves, surgical time was significantly lower among fellowship-trained arthroplasty specialists when compared with other surgeons.
  
  
  CONCLUSIONS
  Our data support that surgeons who perform primarily joint arthroplasty will likely have a decreased surgical time, but similar EBL compared to those who include arthroplasty as only a portion of their practice, however, a number of confounding variables do exist, and additional investigation is warranted.
authors.affiliation: University of Colorado, 12631 E 17th Ave, Rm 4501, B202, Aurora, CO, 80045, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: York
authors.affiliation: University of Colorado, 12631 E 17th Ave, Rm 4501, B202, Aurora, CO, 80045, USA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Logterman
authors.affiliation: Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hak
authors.affiliation: First Department of Orthopaedics, Attikon University Hospital, 1 Rimini Street, 12462, Haidari, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mavrogenis
authors.affiliation: Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA. Cyril.mauffrey@dhha.org.
authors.forename: Cyril
authors.identifier: http://orcid.org/0000-0003-2132-3418
authors.initials: C
authors.lastname: Mauffrey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000193:education / Q000379:methods*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002983:Clinical Competence; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D000072161:Orthopedic Surgeons / Q000592:standards*; D009985:Orthopedics / Q000193:education*; D011183:Postoperative Complications / Q000209:etiology; D014194:Traumatology / Q000592:standards*
keywords: Direct anterior approach; Learning curve; Total hip arthroplasty