Computer navigated total knee arthroplasty: The learning curve

Abstract

The learning curve for computer navigated total knee arthroplasty (TKA) is not well defined. We collected data prospectively on a consultant surgeon's first 50 navigated TKAs. Over the same period, matching data was taken from 50 consecutive cases performed by an expert who has performed over 1000 navigated TKAs. From the first case, the novice navigator was able to achieve the same standard as the expert in terms of post-implant mechanical alignment in the coronal and sagittal planes. Equally, at 6 weeks and one year post-surgery there was no significant difference in the mean Oxford score, mechanical axis and range of movement for the two groups of patients. Operative time was significantly longer for the novice surgeon in the first 20 cases (92 versus 73 min, p < 0.001), but by the final 20 cases there was no difference (72 versus 74 min, p ¼ 0.944). This study shows that the learning curve for navigated TKA is approximately 20 cases and that a beginner can reproduce the results of an expert from the outset.

Re-learning curve for conventional total knee arthroplasty following 30 consecutive computer-assisted total knee arthroplasties

“…As indicated by previous studies [14][15][16], even without prior experience of using CAS, an inexperienced surgeon can expect to achieve an optimal average postoperative mechanical axis upon conversion to CAS technology. In this study, the senior surgeon obtained an average CAS postoperative mechanical axis deviation of 1.99 , considered to be within the range of optimal knee alignment according to prior studies [1][2][3][4][5][6].…”

(vii) Role of Computer Assisted Surgery (CAS) in Training and Outcomes

“…Although this paper assesses a consultant and not a trainee, the results are clear; CAS is able to reduce the learning curve. 12 Improving cognitive skills From the beginning, CAS was proven to be valuable as a measuring tool for skill improvement. 13 Since the introduction of the technology in routine joint arthroplasty, several studies have assessed the potential for CAS to become a tool that would improve trainees' cognitive skills.…”

“…Confirmation of similar findings was published with knee replacement. 12 Around twenty CAS surgical procedures are necessary to pass the learning curve in TKA. Assessment of the learning curve in this paper was measured through the operative time.…”

Minimalinvasive Zugänge am Kniegelenk - evidenzbasierter Vorteil in der Knieendoprothetik?

“…Bei Einführung der Navigation ist die Lernkurve weitergehend beschrieben: Anfänger in der Anwendung dieser Technologie konnten im Rahmen einer Studie bei Implantation einer Knieendoprothese direkt vergleichbare Implantatstellungen, klinische Scores und Beweglichkeiten erreichen. Sie benötigten jedoch 20 Operationen, um vergleichbare Operationszeiten wie erfahrene Anwender zu erreichen[37]. Studie in Form einer Multicenterstudie.…”