Learning Curve Analysis of the Collum Femoris Preserving Total Hip Surgical Technique

Abstract

The aim of this study was to determine whether femoral neck preserving total hip arthroplasty would become less difficult and more efficient during the first 20 cases and to identify potential pitfalls during the introduction of this procedure. The difficulty and efficiency of the initial 20 procedures performed by four surgeons was prospectively determined by analysing a total of 68 video recordings using time-action analysis. This method measures the duration and efficiency of individual actions needed for a surgeon to achieve his or her goal. Afterwards, we reviewed all actions with a long duration and discussed possible causes of delay with the surgeons to identify possible pitfalls. We found a decrease of difficulty and an increase of efficiency during the first 20 cases and a more consistent execution after the initial five cases. Estimating the correct osteotomy level and stem curvature was often difficult, which resulted in a variable stem position. Radiologic analysis demonstrated a tendency for varus position and increased leg length throughout the series, even after the surgeons demonstrated technical proficiency.

Better early functional outcome after short stem total hip arthroplasty? A prospective blinded randomised controlled multicentre trial comparing the Collum Femoris Preserving stem with a Zweymuller straight cementless stem total hip replacement for the treatment of primary osteoarthritis of the hip

“…Surgeon performance bias was prevented by analysing the learning curve and possible pitfalls prior to initiating the trial and establishing minimum requirements for surgeons before participation. 46 Based on this study, the minimum required number of performed procedures prior to participating in this study was initially determined at five for each surgeon. However, to ensure adequate proficiency, the participating surgeons performed 10 procedures prior to participating in the trial.…”

Comparison of collum femoris-preserving stems and ribbed stems in primary total hip arthroplasty

“…The collum femoris-preserving (CFP) short-stem prosthesis (Waldemar Link GmbH, Hamburg, Germany) is a cementless implant, especially appropriate for younger patients. Although there have been many reports of good early-to-midterm results with the CFP prosthesis [ 4 – 8 ], few studies have compared it with those that are more commonly used, in particular prostheses with a ribbed anatomical stem that require excision of the femoral neck for implantation [ 9 , 10 ]. Burchard et al [ 11 ] concluded from a virtual model that the CFP prosthesis has a stress-shielding effect and thus is harmful for bone remodeling.…”

Novel Thyroidectomy Difficulty Scale Correlates with Operative Times

“…Complication rates, blood loss, and operative time serve as surrogates for difficulty. Difficulty scales have been developed for other procedures, often as a means to quantify the learning curve [18][19][20][21]. The notion of difficulty in thyroid surgery literature remains subjective and is limited to case reports, opinions, and technique papers [22][23][24][25][26].…”