Complication Rates for Direct Anterior Total Hip Arthroplasty After Fellowship Compared with Switching Approaches Midcareer: A Multicenter Study of the First 100 Cases

The rate of complications and case complexity were evaluated in the first 100 total hip arthroplasty (THA) procedures in early-career direct anterior approach (DAA)-trained adult-reconstruction surgeons and midcareer surgeons who switched to DAA from a different approach. The study is a multicenter, retrospective analysis that collected data on 500 DAA THAs performed by three early-career surgeons and two midcareer surgeons. The patients of early-career surgeons were older (66.4 vs. 64.1), had a higher body mass index (29.9 vs. 28.4), and increased Charlson Comorbidity Index (2.21 vs. 1.52) compared with midcareer surgeons (p < 0.05). There were no differences in intraoperative complications or 90-day postoperative adverse events (odds ratio 0.45, 95% confidence interval 0.17 – 1.09, p = 0.87). Operative time was significantly greater for the early-career cohort relative to midcareer surgeons (98.1 min vs. 73.8 min, respectively, p < 0.001). Early-career fellowship-trained arthroplasty surgeons have similar complication rates to experienced surgeons switching from a different approach, with higher complexity patients. (Journal of Surgical Orthopaedic Advances 34(3):138-141, 2025)

Key words: direct anterior approach (DAA), total hip arthroplasty, learning curve, arthroplasty fellowship