Orthopedics This Week | February 16, 2016 | Page 12

ORTHOPEDICS THIS WEEK
VOLUME 12, ISSUE 6 | FEBRUARY 16, 2016

tion and more hard bearings. They
used more regional anesthesia and
had to use more drains because they
were losing more blood, and they
allowed the patients to progress
quicker. Their surgical time was
high. Few studies show that you
can do the anterior approach faster
than a mini posterior approach.”
“For a standard posterior approach
it was about two hours and 164
minutes for the anterior approach.
Anesthesia time was longer, the LOS
decreased by a day, and patients lost
more blood. The high volume surgeon probably did the best in terms
of decreasing LOS (4 to 2.2 days).”
“The fracture rate was high: 5%
in the first 20 cases and about 3%
after that. Some of these fractures
were significant in terms of delaying
patient rehab and affecting the long
term outcome. If you examine major
complications, it was 9% with anterior versus 2.6% standard posterior
approach.”
“A study from Mark Pagnano at
Mayo on two high volume surgeons
who are way past the learning curve;
same pain protocol and same rehab
protocol comparing direct anterior
and mini-posterior approaches.
They were pretty much the same,
with some slight advantages for the
posterior approach in some of the
categories. But basically there were
insignificant differences.”
“The most important thing is getting
the parts in right.”
Then in May 2015 Dr. Maloney updated his comments saying:
“The problem that I have with this
technology is that it’s played out in

the marketing data and not in the
scientific data.
A paper done by our faculty and fellows (Woolson, et al., 2008) looked
at what happens when you introduce new technology into a community practice. Remember in North
America, more than 50% of the hips
are done by people who do one or
two hip replacements a year.

What about the fracture rate? Well,
they had a fairly high fracture
rate through a standard posterior
approach—about 3%. It was about
double that in terms of the prevalence during the learning curve with
the anterior approach and calcar
fractures were pretty low. The greater
trochanteric fractures are a problem.
There are some problems—and this
is true of every approach, but I think
when you change your approach, it’s
more likely to happen.”

The study was a cohort study that
looked at a standard posterior approach
in a group of five surgeons and compared that to an anterior approach. It
was consecutive. It used the data from
hospital charts. Inpatient data as well
as data on readmissions.

The Data

We asked the surgeons, ‘Why did
you do it?’ The #1 reason was competition from minima