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Study: Length of learning curve for new primary THA techniques affects short-term clinical outcomes

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BERLIN — Plotting learning curves with data software when an orthopaedic surgeon learns new surgical techniques, such as the muscle-sparing direct anterior approach for total hip arthroplasty, can help identify both technique proficiency and short-term clinical outcome measures, according to a presenter at the 13th EFORT Congress 2012, here.

“We need to learn how to make big changes in surgical technique,” Maansson said. “When we recognize we have the slightest problem, we need to get it fixed,” Lukas Maansson, a consultant orthopaedic surgeon at the Vestre Viken Hospital Trust in Drammen, Norway, said.

Researchers used computer software to map the surgeries of 487 primary total hip arthroplasty (THA) cases which used the muscle-sparing direct anterior approach as performed by 16 surgeons of both consultant and resident grade. Each surgeon performed between one and 160 THAs.

The team found that a period of “slow learning” begins when an orthopaedic surgeon begins learning the direct anterior approach and ends at 95 cases. Orthopaedic surgeons will then enter a period of “accelerated learning” where they will gain a lot of knowledge on the technique for a short period of time before they return to a period of “slow learning” at 206 cases, according to the abstract.

Researchers found the learning curve affected short-term outcome measures, such as perioperative complications, procedure time, length of stay, cup version and rates of revision. Blood transfusions were statistically significant and more common early in the learning curve, but at a low level, according to the abstract. Readmission rates, blood loss, leg length and mean cup inclination did not change at a statistically significant rate over time.

Reference:

• Maansson L, Nordsletten L, Snorrason F, Olsson M. Primary total hip replacement utilizing a muscle sparing direct anterior approach has a long and clinical significant learning curve. Paper #12-3682. Presented at the 13th EFORT Congress 2012. May 23-25. Berlin.
• Disclosure: Maansson has no relevant financial disclosures.