Residents' Learning Curve of Total Knee Arthroplasty Based on Radiological Outcome Parameters: A Retrospective Comparative Study.
TKA
instructive surgery
learning curve
radiological grading system
total knee arthroplasty
Journal
The Journal of arthroplasty
ISSN: 1532-8406
Titre abrégé: J Arthroplasty
Pays: United States
ID NLM: 8703515
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
07
04
2020
revised:
21
06
2020
accepted:
17
07
2020
pubmed:
26
8
2020
medline:
29
4
2021
entrez:
26
8
2020
Statut:
ppublish
Résumé
This study aimed to plot the impact of a learning curve for a resident's first 103 total knee arthroplasties (TKAs) based on radiological deviations and incision to closure time (ICT), and to compare it to 103 matched TKAs performed by a senior surgeon. This is a retrospective comparative study comprising a total of 206 TKAs and evaluated the results based on radiographic outcome and ICT. Radiological evaluation was performed according to a predefined implemented radiological grading system (RGS). t-Tests compared ICT and RGS; data of mechanical axis were observed with Man-Whitey U-tests and Wilcoxon signed-rank-tests. The study included 206 patients (mean age 73 years, mean body mass index of 30). Determining all the deviation points (DP) with the RGS, the deviation ratio for resident vs senior surgeon was 0.96:0.5 DP (P = .0002). The learning curve based on DP showed a decrease over time with statistical significance in the first (26 DP, P = .0001), second (21 DP, P = .0059), and fourth (20 DP, P = .0187) quintiles of implanted cases. The ICT of the resident showed a decrease within the quintiles from 79.45 minutes (first quintile) to 65.17 minutes (fifth quintile), for an improvement of 14.28 minutes. When the quintiles are viewed in relation to the mean operation time of the senior surgeon (mean ICT 66.04 minutes), the mean values of the first and the second quintiles remain statistically significant. Supervised TKA showed statistical significance in the learning curves according to deviations documented with a predefined radiological outcome assessment system as well as to ICTs. Level III, retrospective comparative study.
Sections du résumé
BACKGROUND
This study aimed to plot the impact of a learning curve for a resident's first 103 total knee arthroplasties (TKAs) based on radiological deviations and incision to closure time (ICT), and to compare it to 103 matched TKAs performed by a senior surgeon.
METHODS
This is a retrospective comparative study comprising a total of 206 TKAs and evaluated the results based on radiographic outcome and ICT. Radiological evaluation was performed according to a predefined implemented radiological grading system (RGS). t-Tests compared ICT and RGS; data of mechanical axis were observed with Man-Whitey U-tests and Wilcoxon signed-rank-tests.
RESULTS
The study included 206 patients (mean age 73 years, mean body mass index of 30). Determining all the deviation points (DP) with the RGS, the deviation ratio for resident vs senior surgeon was 0.96:0.5 DP (P = .0002). The learning curve based on DP showed a decrease over time with statistical significance in the first (26 DP, P = .0001), second (21 DP, P = .0059), and fourth (20 DP, P = .0187) quintiles of implanted cases. The ICT of the resident showed a decrease within the quintiles from 79.45 minutes (first quintile) to 65.17 minutes (fifth quintile), for an improvement of 14.28 minutes. When the quintiles are viewed in relation to the mean operation time of the senior surgeon (mean ICT 66.04 minutes), the mean values of the first and the second quintiles remain statistically significant.
CONCLUSION
Supervised TKA showed statistical significance in the learning curves according to deviations documented with a predefined radiological outcome assessment system as well as to ICTs.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
Identifiants
pubmed: 32839061
pii: S0883-5403(20)30803-2
doi: 10.1016/j.arth.2020.07.045
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
154-159Informations de copyright
Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.