Learning curve in relation to radiation exposure, procedure duration and complications rate for Minimally Invasive Chevron Akin (MICA) osteotomy

Abstract

Background Minimally invasive chevron Akin osteotomy (MICA) has become increasingly common and is compatible with the traditional open approaches for hallux valgus correction. However, it is impeded by concerns regarding the steep learning curve, increased radiation exposure and some specific complications. No standardized method for identifying a learning curve exists. We used a reproducible mathematical model to accurately define the learning curve of MICA with a focus on fluoroscopy time, procedure duration and complications rate. Methods We conducted a retrospective study of MICA procedure performed by a single surgeon during his initial experience with this procedure. The chronologic case number was plotted against variables of interest and learning was identified as the point at which instantaneous rate of change of a curve fit to the data set equalled the average rate of change of the data set. Results One hundred cases have been analysed. Learning plateau in operation time was achieved after 29 cases, with the first 29 cases requiring a median of 60 min compared to 40 min for the latter 71 cases. Proficiency in fluoroscopy application occurred in case 30. The median fluoroscopy time for the first 30 cases was 86 seconds compared to 70 seconds in another 70 cases. The complication rate plateau was reached after 42 cases, with 15 of 22 complications occurring in the group operated first. Conclusion Results demonstrate surgeon’s comfort with MICA to minimize operative time and radiation exposure after 30 cases. The plateau is achieved later for complications. Findings impose lag between surgeon feeling comfortable with procedure and a decrease in complications. Further research is reasonable to analyse several surgeons learning curve and to generate a potential reference learning curve that could serve as a normative. Trial registration UKC-MB-KME-33/19, retrospectively registered.

Intraoperative Angle Measurement of Anatomical Structures: A Systematic Review

“…However, there are some drawbacks associated with this form of measurement. Firstly, in the case of fluoroscopy and CT-based technologies, obtaining the images means increased ionizing radiation exposure and its associated risks [ 112 ], the use of specialized equipment, and the need for consistent positioning of the subject and the instrumentation machine, which, in turn, creates difficulties with the existence of a learning curve to master these techniques and added surgery time [ 45 ]. Hawi et al [ 66 ] reported a mean time of min to obtain the images, and a mean time of min to measure ante torsion, which is consistent with the previously mentioned increase in procedure time.…”

“…Finally, there are also increased costs associated with the use of image-based technologies. The equipment itself and the training necessary to use it, as well as the added surgery time, come with added costs that one needs to be aware of before implementing these technologies [ 45 ]. Nevertheless, the use of tracking systems together with 3D representations of the segments could have a deep impact on both the surgical team and the patient, as it can result in a reduction of the operation time and radiation exposure, two of the major limitations of this technology [ 119 ].…”

“…Currently, there are some limitations associated with intraoperative angle adjustments, as most systems imply an increase in complexity and invasiveness, prolonged intervention time, special equipment, exposure to radiation, increased cost, a learning curve, and may be unavailable in some hospitals [ 43 , 44 , 45 ]. Moreover, there is difficulty in using the same system for different types of osteotomies and different places, as these conditions may imply a higher degree of difficulty in obtaining angle measurements [ 20 , 21 , 22 , 44 ].…”