Background There are concerns regarding the complications encountered during the learning curve when switching to a direct anterior approach (DAA) for total hip arthroplasty (THA). The purpose of our study is to report our outcomes and complications after adopting a new approach in a Chinese patient population. Methods From 2016 to 2018, a single surgeon’s first 100 cases with unilateral DAA for THA were reviewed. The patients were divided into 2 groups, the first 50 cases were designated as group A and the second 50 cases were designated as group B. The preoperative, intraoperative, and postoperative clinical data were analyzed. The cumulative summation method (CUSUM) was used to determine the learning curve. Results There was a significant decrease in the complication rate from 44% in the first 50 cases to 16% in the second 50. The first 50 cases showed a significant increase in operating time, length of hospitalization, fluoroscopy, and complications. There was no significant difference in implant position, postoperative leg length discrepancy (LLD), Harris score, or creatine kinase. CUSUM analysis showed that complication rates and operating time reached acceptable and steady state after 88 cases and 72 cases respectively. Conclusions Adopting DAA in a Chinese patient population has its own unique considerations and challenges. Even in the hands of an experienced surgeon, DAA is still a technically demanding procedure.

Robotic arm assisted total knee arthroplasty (RTKA) has many potential benefits including advanced preoperative templating, restoration of mechanical alignment, accuracy of bony resection, robust safety mechanisms, and dynamic gap balancing. One of the most frequently quoted drawbacks preventing experienced surgeons from adopting this technology is the perceived increase in surgical time. This technique paper outlines the general concepts used to improve operating room efficiency as well as the step-by-step workflow to consistently perform RTKA with surgical times under 60 minutes. Although the clinical and functional results of RTKA are just beginning to be described in literature, this manuscript demonstrates that with proper technique and workflow, surgical time should not be a significant factor to deter surgeons from adopting this new technology.

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Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.