Artikel
Negligible effect of surgeon experience on the accuracy and time to perform unrestricted caliper verified kinematically aligned TKA with manual instruments
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Autoren
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Alexander Nedopil
- Orthopädische Klinik, König-Ludwig-Haus, Orthop. Zentrum für Muskuloskelettale Forschung, Lehrstuhl für Orthopädie der Universität Würzburg, Würzburg, Germany
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Maximilian Rudert
- Orthopädische Klinik, König-Ludwig-Haus, Orthop. Zentrum für Muskuloskelettale Forschung, Lehrstuhl für Orthopädie der Universität Würzburg, Würzburg, Germany
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Stephen Howell
- Department of Mechanical Engineering, University of California at Davis, Davis, United States
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Maury Hull
- Department of Mechanical Engineering, University of California at Davis, Davis, United States
| Veröffentlicht: | 25. Oktober 2022 |
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Gliederung
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Objectives: Surgeons performing total knee arthroplasty (TKA) are interested in the accuracy and time it takes to make the four femoral resections that determine the setting of the femoral component. For each femoral resection, accuracy is computed as the mean ± the standard deviation of the planned minus the caliper measurement of the resection thickness (i.e., 0 ± 0.0 mm is most accurate). The present study determined whether the accuracy and time to make the initial femoral resections were differ-ent between experienced (E) (>50 cases) and less-experienced (LE) surgeons that performed unre-stricted caliper verified KA TKA with manual instruments.
Methods: This study analyzed intraoperative verification worksheets for 203 patients treated by ten E surgeons and 58 patients treated by four LE surgeons. The worksheet recorded 1) the planned thickness of the distal medial (DM), distal lateral (DL), posterior medial (PM), and posterior lateral (PL) femoral resections and the caliper measurement of the thickness of the initial resection with a resolution of 0.5 mm, and 2) the time to complete them (Figure 1 [Fig. 1]).
Results and conclusion: Results: The accuracy of the 1044 initial caliper verified femoral resections was significantly closer to the plan for E versus the LE surgeons: 0.0 ± 0.4 vs. -0.3 ± 0.5 for the DM, 0.0 ± 0.5 vs. -0.4 ± 0.6 for the DL, -0.1 ± 0.5 vs. -0.2 ± 0.5 PM, and -0.1 ± 0.5 vs. -0.4 ± 0.6 for the PL resections (p=0.0248). E surgeons completed the initial femoral resections in 12 minutes; 5 minutes faster than LE surgeons (p<0.0001).
Conclusions: Although the LE surgeons took 5 minutes more to complete the initial femoral resections with manual instruments, the accuracy of the experienced surgeons was not clinically different from those with less experience because the <0.5 mm difference between the means and stand-ard deviations was within the caliper's resolution. Surgeons exploring other alignment options and robotic, navigation, and patient-specific instrumentation might find these values helpful when deciding to change (Table 1 [Tab. 1]).
