SELECTIVE TOTAL HIP ARTHROPLASTY APPROACH USE AMONG JUNIOR SURGEONS IMPROVES SAFETY OF INTRODUCING THE ANTERIOR APPROACH: A PROSPECTIVE MULTI-SURGEON COMPARATIVE STUDY

The learning curves associated with independent practice and the anterior approach (AA) have been associated with inferior outcomes. This study compared outcome of the first THAs of junior, fellowship-trained, surgeons who perform THA through both anterior and posterior (PA) approaches, and of THAs performed over the same period by senior surgeons who perform THA through either AA or PA, to determine whether: 1. Fellowship training and selective practice allows for safe introduction of AA into practice; and 2. Whether selective approach-use influences outcome. This is a prospective, consecutive study of 1200 primary THAs (1134 patients), operated between 2018–2020 by four surgeons in two academic, centers. The first 800 THAs of two junior, dual-approach, surgeons (AA/PA: 400/400) were compared with 400 THAs (AA/PA: 200/200) cases of two senior, single-approach, surgeons. Most patients were females (54%), mean age was 65±12years-old and mean BMI was 29±6. Complication- reoperation-, and revision rates, and patient-reported outcome (pre- and post-op) using Oxford-Hip-Score (OHS) were analyzed. At 2.5±1 year follow-up, there were 33 complications (2.7%), 28 re-operations (2.3%) and 22 revisions (1.9%). Mean ΔOHS was 20±8. There was no difference in complication rate between junior and senior surgeons with AA (Junior: 7/400, Senior: 6/200; p=0.17) or PA (Junior: 13/400; Senior: 7/200; p=0.9). Similarly, no difference in re-operation, or revision (p=0.2) or ΔOHS (p=0.49) was detected between surgeon groups for each approach. Amongst juniors there were no differences in complications (AA:7/400 vs. PA:13/400 p=0.17), revisions (AA:4/400 vs. PA:9/400; p=0.1) or ΔOHS (AA:20±8 vs. PA:20±8; p=0.9) between approaches. Contemporary training and selective approach-use minimizes the learning curve associated with independent practice and AA allowing junior staff to have equivalent outcomes to established, senior surgeons in both approaches. We would thus advocate for selective approach use amongst junior arthroplasty surgeons when introducing the AA into practice.