Surgical learning curve in reverse shoulder arthroplasty for proximal humerus fractures

Abstract

Background Fracture reverse shoulder arthroplasty (fRSA) in geriatric, complex dislocated proximal humerus fractures is becoming the standard treatment next to conservative treatment. fRSA is a multifaceted, reasonably challenging procedure of which functional outcomes and complication rates are likely to depend on the experience of the surgeon. The goal of this study was to determine whether there is a learning curve for fRSA. Methods All patients with a dislocated multipart proximal humerus fracture that were treated with an fRSA between 2013 and 2019 in a specialized institution were included. The functional outcomes (Constant Shoulder Score, Oxford Shoulder Score, and range of motion), complications, and operation time of fRSA were assessed with linear regression plots and cumulative summation analysis to establish whether a learning curve was present. Results In this cohort study, 50 patients were included. They had a mean age of 77.1 years and were treated with an fRSA by one trauma surgeon. Learning curves were distinguished for functional outcomes, complications, and operation time based on learning targets for daily activity and the mean complications and operation time. Results indicated that an optimal treatment is achieved after performing 20 fRSAs. Conclusion The results show that functional outcomes of PHFs treated with an fRSA improve with surgical experience. Also, outcomes are getting less variable after about 20 procedures. Surgeons starting this procedure should be aware of the learning curve and, therefore, should consider guidance from an experienced surgeon to swiftly optimize functional outcomes and prevent unnecessary complications.

Dual Surgeon Operating in Reverse Geometry Total Shoulder Replacement: The Learning Curve and Its Effects on Complication Rates

“…Similarly, Kempton et al reported on a case series of 200 RGTSRs showing a fall in the complication rate of 23.1% in the first 40 cases to 6.5% in the last 160 cases [8]. The surgeon's learning curve, and the reduction in complications and reduced operating times associated with it, has similarly been reported by more recent publications, not only in the realm of shoulder surgery [9][10][11][12][13]. We have shown a similar fall in complication rates over time, from 24.4% (first 37 cases) to 10.8% (second 37 cases).…”

Results of single-incision distal biceps tendon repair for early-career upper-extremity surgeons

“… 42 , 43 , 47 In the upper extremity, Blaas et al supported a previously established operative learning curve of 15 cases for reverse total shoulder arthroplasty for patients with proximal humerus fractures. 4 , 7 In spine, a study by Yu et al reported a learning curve of 17-18 cases with respect to operative time for cases involving a robot-assisted pedicle screw fixation while an operative time learning curve of 58 cases for the lumbar decompressive laminectomy using a biportal endoscopic approach was reported by Park et al. 35 , 48 Beyond orthopedics, CUSUM-based operative learning curves have reported to be approximately 30 cases for robot-assisted colorectal surgery, approximately 50 cases in surgical resection of advanced ovarian cancer, and 43 cases for robot-assisted transabdominal preperiotoneal repair of inguinal hernias.…”

Influencia de la consolidación de las tuberosidades en los resultados clínicos de la prótesis invertida para fracturas de húmero proximal

“…Creemos importante destacar que la PIH para el manejo de las FHP tiene una curva de aprendizaje larga que implica realizar, como mínimo, 20 procedimientos. 22 Por lo tanto, consideramos conveniente que este tipo de cirugías esté en manos de cirujanos con experiencia en trauma y reconstrucción articular del hombro para lograr resultados óptimos.…”