Technical Obstacles in Total Knee Arthroplasty Learning: A Steps Breakdown Evaluation

INTRODUCTION: Total knee arthroplasty (TKA) is a common procedure practiced in both the community and academic setting and one that all orthopaedic surgery residents are expected to become competent in. The aim of this study is to determine the most common technical obstacles encountered during TKA learning. METHODS: This is a prospective, cohort observational study performed from September 2017 to April 2018. After routine primary TKA, faculty completed a survey of the trainees in the case through a series of 10 questions. The questions were scored on a 0 to 5 scale based on performance proficiency. Exclusion criteria included revision TKA and complex primary TKA. Participants were divided into two groups based on year in training multiplied by the number of cases performed: group 1 (junior—n = 44) was <20, whereas group 2 (senior—n = 59) was >20. RESULTS: The senior experience group scored higher for all questions (P < 0.05). Skills competency and technique were related to each other, independent of experience. When evaluating the relationships between the steps, the scores on every step were linked to the previous and following step at all experience levels (P < 0.05), with some dictating the success of the rest of the case with high significance (P < 0.01). CONCLUSION: We have shown that most senior-level residents cannot necessarily perform all steps of a TKA proficiently, potentially leading to issues in independent practice. We have also demonstrated that residents have the most difficulty with conceptual tasks, rather than technical ones. Teaching has traditionally focused on technical skills, but this implies conceptual tasks may require more teaching focus.