Issue link: https://beckershealthcare.uberflip.com/i/808731
25 Executive Roundtable 2. Component placement accuracy is greatly improved via the direct anterior approach compared to THA completed via the posterior approach. Recent research data from our center reviewing over 1,000 cases performed by 10 hip/ knee arthroplasty specialists demonstrates much higher acetabular position accuracy using the anterior approach. Using the anterior approach with intra-operative fluoros- copy increased the accuracy even further. 3. Using the inter-nervous/intermuscular surgical plane for the direct anterior approach allows for complete muscle recovery in both the primary and revision setting. This has shown to be important in revision cases to help prevent scarring and muscular dysfunction that can be seen in other surgical approaches. Q: In terms of disadvantages, how steep is the learning curve to learn the direct anterior approach? What is the best way for a surgeon to tackle learning this procedure? TE: The learning curve can be difficult. It takes commitment and time to become proficient. I think [surgeons] should go to a course (or multiple courses) and work on cadavers to get fa- miliar with the approach. I think you should go watch a surgeon do the surgery. And then, ideally, the first one you do, you have someone there to proctor you, and help you for the first couple times you're doing it. Medacta's AMIS Education Platform has provided me and others with the ability to do this. Once you do a few, then I think you should go back and do another surgeon visit and lab and then go back and continue doing the surgery; each time you visit a surgeon, you pick up nuances that make the surgery better. Q: What are the clinical benefits of same-day surgery in comparison to traditional inpatient THA? Does your pre- ferred approach present any particular advantages or chal- lenges, specific to the ambulatory setting? CF: The biggest advantage is safety. If you're a healthy patient, you certainly don't need to be in the hospital for a day or three with people who have antibiotic-resistant infections or multiple patients raising risk of medication errors. In the outpatient setting, you can create the exact same care model without the hospital stay. We are giving these patients the exact same pain medication, anticoagulant and therapy that they would get in the hospital. We send a home health nurse out to the patient's home the evening of surgery, followed by both a nurse and therapist to their house the next morning. It's all part of the bundle. TE: I agree with this and I think it bears repeating — sick people are in hospitals, so I prefer my patients limit their stay. So, if they are medically able and safe to go home, my desire is to get them out of the hospital setting as soon as possible. Q: Would you say patients are increasingly seeking sur- geons who utilize the anterior approach for THA? JM: There has been a steady increase in patient demand for THA via the direct anterior approach. Some patients have been influenced by individual physician advertisement, which may or may not contain accurate clinical data. More commonly, many individuals learn about the anterior approach for THA from other patients. This "word of mouth" transfer of information is probably the most important testimony to the technique. TE: Yes, in my practice I have a lot of patients who are com- ing to see me because I perform the anterior approach. They've already seen surgeons who don't do it and they have elected to come to me. They're doing their research — this is a patient- driven procedure at this point. CF: I agree, and nobody comes in and asks for the posterior approach. Q: How has the industry evolved to make way for this THA approach, benefitting the patient, surgeon and hospital? TE: I think that educational programs are improving signifi- cantly; they're developing approach-specific instruments that are especially designed for the anterior hip replacements. The companies are providing tables to manipulate the leg that makes it easier to do the surgery with only one assistant. They are also facilitating discussion of postoperative protocols that facilitate faster home discharge. CF: I did almost 800 anterior hips without a specialized table and it was physically brutal sometimes in more muscular patients. Now, I use the Medacta AMIS table; when you use the Medacta hip, the company supplies the table at no cost. This is especially important in the outpatient center, where an additional $100,000 capital expenditure can be quite daunting. Q: Looking forward, do you believe procedures will con- tinue to move to the outpatient setting? CF: I think both the patients and insurance companies are going to demand it. Patients will because of the safety factor, and the insurance companies will because they see tens of thousands of dollars of savings per case compared to the hospital. JM: As hospital costs and demand for quality both increase, the percentage of outpatient hip replacements will climb. Our chal- lenge will be to create and perfect the most effective technique for total hip arthroplasty. TE: I think the trend is going to continue; patients are driving it because they want to go home, and economically it makes sense because it's less expensive. n Medacta® International is a world leading manufacturer of orthopedic implants, neurosurgical systems, and instrumenta- tion. Medacta's revolutionary approach and responsible innovation have resulted in standard of care breakthroughs in hip replacement with the AMIS® system and total knee replacement with MyKnee® patient matched technology. Over the last 10 years, Medacta has grown dramatically by taking a different approach and placing value on all aspects of the care experience from design to training to sustainability. Medacta is headquartered in Castel San Pietro, Switzerland, and operates in over 30 countries. To learn more about Medacta International, please visit www.medacta.com or follow @ Medacta on Twitter.