Clinical Orthopaedics & Related Research. 463:90-97, October 2007.
Cobb, Justin P FRCS; Kannan, Vijaraj MD; Brust, Klaus MD; Thevendran, Gow MD
Hip resurfacing is a novel technique with a substantial learning curve resulting
in poor outcomes for many patients. We asked whether navigation would influence
this learning curve and accuracy of implantation. Twenty medical students
earning their degree in surgical technology participated in a randomized trial.
We provided instruction about the surgical technique, including the use of
conventional instrumentation, the use of a computed tomography-based planner for
hip resurfacing, and a navigation system. The 20 students were then split into
three groups undertaking these tasks in three different orders. Synthetic femurs
replicated normal, osteoarthritis, slipped capital femoral epiphysis, and coxa
valga. The mean error using the conventional method to insert a guidewire was
23[degrees]; using the computed tomography plan method it was 22[degrees]; and
using navigation was 7[degrees]. Students produced similar accuracy, even in
their first attempt, on difficult anatomy when provided navigation. Motivated
students rapidly achieved an expert level of accuracy when provided with
navigation. Learning a conventional method first did not improve performance,
even in difficult cases. Our data suggest navigation may play an important role
in reducing the learning curve in hip resurfacing arthroplasty and other tasks
in arthroplasty in which a high degree of accuracy is clinically important.
(C) 2007 Lippincott Williams & Wilkins, Inc.