ArticleActa orthopaedica2022
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.
Article in Acta orthopaedica, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 5 of them syntheses that pooled it.
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Who cites it
33 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- The effect of surgeon volume on outcomes after total hip arthroplasty: a systematic review and meta-analysis.Archives of orthopaedic and trauma surgery · 2026Pooled it
- Comparative efficacy of direct anterior approach versus conventional surgical approaches in total hip arthroplasty: a systematic review and meta-analysis of randomized clinical trials.Journal of orthopaedic surgery and research · 2025Pooled it
- Comparison of direct anterior vs. posterior approach in primary total hip arthroplasty: a systematic review and meta-analysis on enhanced recovery after surgery.Frontiers in surgery · 2025Pooled it
- The Direct Superior Approach in Total Hip Arthroplasty: A Systematic Review.JBJS reviews · 2024Pooled it
- Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Pooled it
- Trial
- Determining the learning curve for anterolateral supine total hip arthroplasty: a retrospective analysis of six hundred and forty consecutive cases performed by a single surgeon.International orthopaedics · 2026Article
- Association between intraoperative fluoroscopy for anterior approach total hip arthroplasty and short-term revision risk: an analysis based on 49,878 cases from the Dutch Arthroplasty Register.Acta orthopaedica · 2026Article
- Comparable Early Functional Recovery Between Robotics-Assisted Superior Transverse Atraumatic Reconstruction (STAR) Total Hip Arthroplasty and the Direct Anterior Approach: A Six-Month Propensity-Matched Study.Journal of clinical medicine · 2026Article
- Reduction in Operative Time After Implementation of Computer-Assisted Navigation in Direct Anterior Total Hip Arthroplasty With Consideration of Learning Curve.Arthroplasty today · 2026Article
- A novel iliofemoral classification for assessing surgical difficulty in direct anterior approach total hip arthroplasty: a retrospective cohort study.BMC musculoskeletal disorders · 2026Article
- Oblique Bikini Incision Versus Longitudinal Incision for Direct Anterior Approach Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.Health science reports · 2026Review
- Transition from the posterior to the Superior Transverse Anatomic Reconstruction (STAR) approach for total hip arthroplasty : no learning curve and improved early postoperative outcomes.Bone & joint open · 2026Article
- Applied anatomical study of direct anterior approach total hip arthroplasty: optimizing surgical procedures and shortening learning curve.Archives of orthopaedic and trauma surgery · 2025Article
- 2050: An Arthroplasty Odyssey.Healthcare (Basel, Switzerland) · 2025Article
- Total Hip Arthroplasty Using a Direct Anterior Approach Reduces Postoperative Leg Length Differences by Preserving the Medial Iliofemoral Ligament.Arthroplasty today · 2025Article
- [Inclusion of AMIS surgical approach in the Methods Used for Total Hip Arthroplasty: Learning Curve, Risks, Surgical Technique].Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca · 2025Article
- Hip hemiarthroplasty through the anterior based muscle sparing approach for femoral neck fractures: an operative technique.Frontiers in surgery · 2025Article
- Comparison of surgical efficacy between direct anterior approach and posterolateral approach in the treatment of sarcopenia with femoral neck fractures.BMC geriatrics · 2024Article
- For many but not for all: the bikini incision direct anterior approach for total hip arthroplasty. A narrative review.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2024Review
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11 authors.
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No grant is acknowledged in the PubMed record.
Abstract
background and purposeIn the last decade, the direct anterior approach (DAA) for total hip arthroplasty (THA) has become more popular in the Netherlands. Therefore, we investigated the learning curve and survival rate of the DAA in primary THA, using data from the Dutch Arthroplasty Register (LROI). PATIENTS AND
methodsWe identified all patients who received a primary THA using the DAA in several high-volume centers in the Netherlands between 2007 and 2019 (n = 15,903). Procedures were ordered per surgeon, using date of operation. Using the procedure number, operations were divided into 6 groups based on the number of previous procedures per surgeon (first 25, 26-50, 51-100, 101-150, 151-200, > 200). Data from different surgeons in different hospitals was pooled together. Revision rates were calculated using a multilevel time-to-event analysis.
resultsPatients operated on in group 1-25 (hazard ratio [HR] 1.6; 95% CI 1.1-2.4) and 26-50 (HR 1.6; CI 1.1-2.5) had a higher risk for revision compared with patients operated on in group > 200 THAs. Between 50 and 100 procedures the revision risk was increased (HR 1.3; CI 0.9-1.9), albeit not statistically significant. From 100 procedures onwards the HR for revision was respectively 1.0 (CI 0.6-1.6) and 0.8 (CI 0.5-1.4) for patients in operation groups 101-150 and 151-200. Main reasons for revision were loosening of the stem (29%), periprosthetic infection (19%), and dislocation (16%).
interpretationWe found a 64% increased risk of revision for patients undergoing THA using the DAA for the first 50 cases per surgeon. Between 50 and 100 cases, this risk was 30% increased, but not statistically significant. From 100 cases onwards, a steady state had been reached in revision rate. The learning curve for DAA therefore is around 100 cases.
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