Outcomes and component-positioning in total knee arthroplasty may be comparable between supervised trained surgeons and their supervisor

Abstract

Purpose: There are concerns that malalignment in total knee arthroplasty (TKA) occurs with less experienced surgeons. This study investigates the influence of surgical experience on TKA outcomes. Materials and methods: Nineteen patients (38 knees) who underwent bilateral TKA between 2011 and 2015 were included. A supervisor performed knee replacements associated with lower Knee Society Scores (KSS); trainee surgeons operated on the other knee. Knees were categorized into two groups: operations by the supervisor (group S) versus operations by trainee surgeons (group T). Range of motion (ROM), KSS, operative time, hip-knee-ankle angle, and femoral and tibial component angle were evaluated. Results: The mean operative time was 92.5 min in group S and 124.2 min in group T (p < 0.01). The mean postoperative maximal flexion was 113.2°in group S and 114.2°in group T (not significant). The mean postoperative KSS was 92.9 in group S and 93.9 in group T (not significant). No significant differences between groups in terms of proportion of inliers for the hip-knee-ankle angle, femoral component angle, or tibial component angle were observed. Conclusions: Although operative time was significantly longer for trainee surgeons versus the supervisor, no significant differences in ROM, KSS, or component positioning between supervisor and trainee surgeons were observed. Level of evidence: IV (retrospective case series design).

The Accuracy of a Portable Accelerometer-Based Navigation System for Tibial Alignment Can be Reliable during Total Knee Arthroplasty for Obese Patients

“…Nevertheless, the accuracy of component placement remains the same in the presence of a supervisor, even when the surgeon is less experienced. 21 Third, a high BMI does not necessarily mean that the soft tissue around the ankle joint is thicker; some individuals with a low BMI may have edema that is difficult to recognize. Fourth, PTS was measured using a short film, which is not accurate and has a margin of error of approximately 2° 22 .…”

Resident Impact on Primary Total Knee Arthroplasty: A Consecutive Series Under a Single Surgeon

“…Previously studied research has helped to identify and acknowledge these learning curves with emphasis on outcomes [ 9 ]. These learning curves have been shown to decrease over time with larger case volumes and radiographic alignment comparable to that of a senior arthroplasty surgeon [ 10 , 11 ]. The current findings demonstrate that resident involvement did not significantly impact coronal plane radiographic alignment of the prosthesis.…”

“Boot Sign” of Anterior Femoral Condylar Resectional Shape during Total Knee Arthroplasty Is More Frequent in Asian Patients

“…The rotational alignment of the femoral component in total knee arthroplasty (TKA) has been reported to be an important factor in patellofemoral and tibiofemoral knee kinematics [1][2][3][4][5]. Excessive internal rotation of the femoral component with respect to the femoral posterior condylar axis (PCA) can lead to knee pain and stiffness, which 2 of 10 negatively affects clinical outcomes [2,[6][7][8][9].…”