The Rise of the Direct Anterior Approach: Trends, Learning Curves, and Patient Characteristics of 63,182 Primary Total Hip Arthroplasties in the Dutch Arthroplasty Register (LROI).

BACKGROUND: The use of the direct anterior approach (DAA) in total hip arthroplasty (THA) has steadily increased in the Netherlands since 2007. The aim of this study was to outline how the DAA has been implemented in the Netherlands. Moreover, we investigated the learning curve of the DAA at a hospital level, and explored patient characteristics of the DAA compared with other approaches and during the learning phase after implementing the DAA. METHODS: In this population-based cohort study, we included all primary THAs between 2007 and 2020 (n = 342,473) from the Dutch Arthroplasty Register. For hospitals implementing the DAA (n > 20), patients were categorized in 4 experience groups using the date of surgery: 1 to 50, 51 to 100, 101 to 150, or > 150. Subsequently, data from different hospitals were pooled and survival rates were calculated using Kaplan-Meier survival analyses. Adjusted revision rates were calculated using mixed Cox proportional hazard models (frailty). RESULTS: The use of the DAA gradually rose from 0.2% in 2007 to 41% of all primary THAs in 2020. A total of 64 (56%) hospitals implemented the DAA. However, not all hospitals continued using this approach. After implementation, the 5-year survival rate for the first 50 procedures was significantly lower (96% confidence interval [CI] 95.8 to 97.2) compared to >150 procedures (98% CI 97.7 to 98.1). Multivariable Cox hazard analyses demonstrated a higher risk of revision during the first 50 procedures compared with >150 procedures (hazard ratio 1.6, CI 1.3 to 2.0). CONCLUSIONS: The use of DAA for primary THA significantly increased. For hospitals implementing DAA, a considerable learning curve with increased revision risk was seen.

Quality of life after staged revision for infected total hip arthroplasty: a systematic review.

INTRODUCTION: The aim of this review was to assess (health-related) quality of life ([HR]Qol) after 1-stage or 2-stage revision for prosthetic joint infection of the hip (PJI). Additionally, we compared (HR)QoL scores with normative population scores to assess whether QoL is reduced after revision for PJI. METHODS: A systematic search was performed in Embase, Cochrane and Pubmed. We included articles that reported (HR)QoL questionnaires after staged revision for hip PJI with a minimum follow-up of 24 months. Methodological quality was assessed using the MINORS score. RESULTS: The search produced 11,195 results. We selected 12 papers describing 2-stage revisions. The mean MINORS score was 9.8. Average WOMAC scores of 185 patients with a mean follow-up of 69.8 months were 73.Average Short Form 36 (SF-36) scores of 159 patients with a mean follow-up of 40.7 months were 40.4 for the physical component score (PCS) and 51.6 for the mental component score (MCS). Average Short Form 12 (SF-12) scores of 154 patients with a mean follow-up of 73.4 months were: a PCS of 35.4 and a MCS of 49.1. The WOMAC, SF-12 (PCS) and SF-36 (PCS) were respectively 12%, 26.7% and 14.8% lower, compared to normative values. DISCUSSIONS: Patients who underwent 2-stage revision for hip PJI had substantially lower (physical component) (HR)QoL scores, but mental scores were comparable to the general population.