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Observational Study
. 2018 Feb;28(2):269-275.
doi: 10.1007/s00590-017-2049-y. Epub 2017 Oct 13.

The learning curve in short-stem THA: influence of the surgeon's experience on intraoperative adjustments due to intraoperative radiography

Lennard Loweg  1 , Karl Philipp Kutzner  2 , Matthias Trost  3 , Marlene Hechtner  4 , Philipp Drees  5 , Joachim Pfeil  1 , Michael Schneider  1
Affiliations
Observational Study

The learning curve in short-stem THA: influence of the surgeon's experience on intraoperative adjustments due to intraoperative radiography

Lennard Loweg et al. Eur J Orthop Surg Traumatol. 2018 Feb.

Abstract

Introduction: Short-stem THA has become increasingly popular over the last decade. However, implantation technique differs from conventional THA and thus possibly involves a distinct learning curve. The purpose of this study was to evaluate the value of intraoperative radiography and the influence of the surgeon's experience on intraoperative adjustments in short-stem THA.

Methods: A total of 287 consecutive short-stem THAs, operated by a total of 24 senior consultants, consultants and residents in training, were prospectively included. Intraoperative radiography was performed after trial reduction. Preoperative planning and intraoperative outcome with regard to positioning, sizing of components as well as resulting offset and leg length were compared. Frequency, reason and type of intraoperative adjustments were documented in relation to the surgeon's experience. Operation time was assessed.

Results: One hundred and fifty-six (54.4%) procedures were carried out by one of three senior consultants, and a total of nine consultants and 12 residents in training performed 105 (36.6%) and 26 (9.0%) operations, respectively. In 121 cases (42.2%), intraoperative adjustments were made following intraoperative radiography. Intraoperative adjustments of one or more components were made by senior consultants in 51 cases (32.7%), by consultants in 53 cases (50.5%) and by residents in 17 cases (65.4%), respectively. The most common cause was undersizing of the stem. Operation time varied markedly between groups of surgeons.

Discussion: Short-stem THA involves a learning curve. Intraoperative radiography is decisive for prevention of malpositioning and undersizing of components, as well as loss of offset and leg length discrepancies. Hence, it should be considered mandatory, especially for less experienced surgeons.

Keywords: Adjustments; Intraoperative radiography; Learning curve; Optimys; Short stem; Total hip arthroplasty.

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Conflict of interest statement

Prof. Dr. Joachim Pfeil has a contract as medical advisor to Mathys Ltd. Bettlach, Switzerland. All other authors declare that they have no conflict of interests.

Figures

Fig. 1
Fig. 1
a Preoperative planning. b Intraoperative radiography with the trial implant of the planned size. Compared to the preoperative planning, it appears to be undersized and misses lateral cortical contact. c Radiography with the original implant after upsizing. The result shows adequate positioning matching the preoperative planning
Fig. 2
Fig. 2
Percentage of intraoperative adjustments based on components after performing intraoperative radiography
Fig. 3
Fig. 3
Percentage of intraoperative adjustments made following intraoperative radiography for the three groups of surgeons providing different levels of experience in short-stem THA
See this image and copyright information in PMC

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References

    1. Kutzner KP, Kovacevic MP, Freitag T, Fuchs A, Reichel H, Bieger R. Influence of patient related characteristics on early migration in calcar-guided short-stem total hip arthroplasty: a 2-year migration analysis using EBRA-FCA. J Orthop Surg Res. 2016;11:29. doi: 10.1186/s13018-016-0363-4. - DOI - PMC - PubMed
    1. Schmidutz F, Graf T, Mazoochian F, Fottner A, Bauer-Melnyk A, Jansson V. Migration analysis of a metaphyseal anchored short-stem hip prosthesis. Acta Orthop. 2012;83:360–365. doi: 10.3109/17453674.2012.712891. - DOI - PMC - PubMed
    1. Briem D, Schneider M, Bogner N, et al. Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis. Int Orthop. 2011;35:655–660. doi: 10.1007/s00264-010-1020-x. - DOI - PMC - PubMed
    1. Kutzner KP, Donner S, Schneider M, Pfeil J, Rehbein P. One-stage bilateral implantation of a calcar-guided short-stem in total hip arthroplasty. Oper Orthop Traumatol. 2017;29(2):180–192. doi: 10.1007/s00064-016-0481-5. - DOI - PMC - PubMed
    1. Kutzner KP, Kovacevic MP, Roeder C, Rehbein P, Pfeil J. Reconstruction of femoro-acetabular offsets using a short-stem. Int Orthop. 2015;39:1269–1275. doi: 10.1007/s00264-014-2632-3. - DOI - PubMed

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