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A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon

After starting an orthopedic practice, a surgeon with a fellowship in mechanically aligned (MA) TKA initiated this study to characterize their learning curve after they switched to unrestricted kinematic alignment (KA) TKA using manual instruments. Accordingly, the present study determined for the i...

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Autores principales: Nedopil, Alexander J., Dhaliwal, Anand, Howell, Stephen M., Hull, Maury L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9320158/
https://www.ncbi.nlm.nih.gov/pubmed/35887649
http://dx.doi.org/10.3390/jpm12071152
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author Nedopil, Alexander J.
Dhaliwal, Anand
Howell, Stephen M.
Hull, Maury L.
author_facet Nedopil, Alexander J.
Dhaliwal, Anand
Howell, Stephen M.
Hull, Maury L.
author_sort Nedopil, Alexander J.
collection PubMed
description After starting an orthopedic practice, a surgeon with a fellowship in mechanically aligned (MA) TKA initiated this study to characterize their learning curve after they switched to unrestricted kinematic alignment (KA) TKA using manual instruments. Accordingly, the present study determined for the inexperienced (IE) surgeon the number of cases required to achieve consistent femoral resections and operating times, and whether the femoral resection accuracy, patient-reported outcome measures (PROMs), and component alignment were different from an experienced (E) surgeon. This prospective cohort study analyzed the IE surgeon’s first 30 TKAs, all performed with KA, and 30 consecutive KA TKAs performed by an E surgeon. The resection accuracy or deviation was the calipered thickness of the distal and posterior medial and lateral femoral resections minus the planned resection thickness, which was the thickness of the corresponding condyle of the femoral component, minus 2 mm for cartilage wear, and 1 mm for the kerf of the blade. Independent observers recorded the femoral resection thickness, operative times, PROMs, and alignment. For each femoral resection, the deviation between three groups of patients containing ten consecutive KA TKAs, was either insignificant (p = 0.695 to 1.000) or within the 0.5 mm resolution of the caliper, which indicated no learning curve. More than three groups were needed to determine the learning curve for the operative time; however, the IE surgeon’s procedure dropped to 77 min for the last 10 patients, which was 20 min longer than the E surgeon. The resection deviations of the IE and E surgeon were comparable, except for the posterolateral femoral resection, which the IE surgeon under-resected by a mean of −0.8 mm (p < 0.0001). At a mean follow-up of 9 and 17 months, the Forgotten Joint Score, Oxford Knee Score, KOOS, and the alignment of the components and limbs were not different between the IE and E surgeon (p ≥ 0.6994). A surgeon that switches to unrestricted KA with manual instruments can determine their learning curve by computing the deviation of the distal and posterior femoral resections from the planned resection. Based on the present study, an IE surgeon could have resection accuracy, post-operative patient outcomes, and component alignment comparable to an E surgeon.
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spelling pubmed-93201582022-07-27 A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon Nedopil, Alexander J. Dhaliwal, Anand Howell, Stephen M. Hull, Maury L. J Pers Med Article After starting an orthopedic practice, a surgeon with a fellowship in mechanically aligned (MA) TKA initiated this study to characterize their learning curve after they switched to unrestricted kinematic alignment (KA) TKA using manual instruments. Accordingly, the present study determined for the inexperienced (IE) surgeon the number of cases required to achieve consistent femoral resections and operating times, and whether the femoral resection accuracy, patient-reported outcome measures (PROMs), and component alignment were different from an experienced (E) surgeon. This prospective cohort study analyzed the IE surgeon’s first 30 TKAs, all performed with KA, and 30 consecutive KA TKAs performed by an E surgeon. The resection accuracy or deviation was the calipered thickness of the distal and posterior medial and lateral femoral resections minus the planned resection thickness, which was the thickness of the corresponding condyle of the femoral component, minus 2 mm for cartilage wear, and 1 mm for the kerf of the blade. Independent observers recorded the femoral resection thickness, operative times, PROMs, and alignment. For each femoral resection, the deviation between three groups of patients containing ten consecutive KA TKAs, was either insignificant (p = 0.695 to 1.000) or within the 0.5 mm resolution of the caliper, which indicated no learning curve. More than three groups were needed to determine the learning curve for the operative time; however, the IE surgeon’s procedure dropped to 77 min for the last 10 patients, which was 20 min longer than the E surgeon. The resection deviations of the IE and E surgeon were comparable, except for the posterolateral femoral resection, which the IE surgeon under-resected by a mean of −0.8 mm (p < 0.0001). At a mean follow-up of 9 and 17 months, the Forgotten Joint Score, Oxford Knee Score, KOOS, and the alignment of the components and limbs were not different between the IE and E surgeon (p ≥ 0.6994). A surgeon that switches to unrestricted KA with manual instruments can determine their learning curve by computing the deviation of the distal and posterior femoral resections from the planned resection. Based on the present study, an IE surgeon could have resection accuracy, post-operative patient outcomes, and component alignment comparable to an E surgeon. MDPI 2022-07-16 /pmc/articles/PMC9320158/ /pubmed/35887649 http://dx.doi.org/10.3390/jpm12071152 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nedopil, Alexander J.
Dhaliwal, Anand
Howell, Stephen M.
Hull, Maury L.
A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon
title A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon
title_full A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon
title_fullStr A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon
title_full_unstemmed A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon
title_short A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon
title_sort surgeon that switched to unrestricted kinematic alignment with manual instruments has a short learning curve and comparable resection accuracy and outcomes to those of an experienced surgeon
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9320158/
https://www.ncbi.nlm.nih.gov/pubmed/35887649
http://dx.doi.org/10.3390/jpm12071152
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