Department of Orthopaedic Surgery, University Hospitals Leuven, Katholieke Universiteit Leuven, Weligerveld 1, 3012, Pellenberg, Belgium.
Knee Surg Sports Traumatol Arthrosc. 2011 Oct;19(10):1662-8. doi: 10.1007/s00167-010-1378-8. Epub 2011 Jan 14.
Implant registries have been effective in detecting poorly performing implants and surgical strategies. They learn us however little about many variables that may be equally important to the final result. Today, no standards of care exist for performing total knee arthroplasties (TKA), and little is known about the variability that exists amongst surgeons performing this procedure.
A questionnaire with 39 aspects regarding standard surgical routine during TKA was sent to all 112 members of the Belgian Knee Society. Surgeons were stratified according to surgical experience and surgical volume.
An important number of routines were performed as standard by the majority (>70%) of surgeons. Surgeons however significantly differed in the following aspects of the procedure: radiographic evaluation, use of minimally invasive surgery (MIS), preferred landmark for femoral component rotation, method of closure and activities allowed postoperatively. Both surgical experience and surgical volume had a significant effect, but their influence on strategies was different. Less-experienced surgeons used the posterior condylar line as their reference for femoral component rotation significantly more frequent than more-experienced surgeons and were more aggressive towards postoperative sports activities compared to more-experienced surgeons. High-volume surgeons used significantly more frequent MIS and low-volume surgeons preferred a more extensive postoperative radiographic evaluation.
Data of this study show that an important number of routines are performed similarly by the majority of surgeons, and that minor but significant differences exist between high-volume versus low-volume surgeons, and between experienced versus less-experienced surgeons.
Case series, Level IV.
植入物登记处已成功地发现了性能不佳的植入物和手术策略。然而，它们使我们对许多可能对最终结果同样重要的变量知之甚少。如今，尚无针对全膝关节置换术（TKA）的护理标准，而且对于执行该手术的外科医生之间存在的变异性知之甚少。
向比利时膝关节协会的 112 名成员发送了一份包含 39 个 TKA 标准手术常规问题的问卷。根据手术经验和手术量对外科医生进行分层。
大多数（>70％）外科医生将许多常规操作作为标准操作。但是，外科医生在以下手术方面存在显著差异：影像学评估、微创外科（MIS）的使用、股骨组件旋转的首选标志、闭合方法和术后允许的活动。手术经验和手术量都有显著影响，但它们对策略的影响不同。经验较少的外科医生比经验更丰富的外科医生更频繁地将后髁线用作股骨组件旋转的参考，并且与经验更丰富的外科医生相比，他们对术后运动活动更具侵略性。高手术量的外科医生更频繁地使用 MIS，而低手术量的外科医生则更喜欢更广泛的术后影像学评估。
本研究的数据表明，大多数外科医生的大多数常规操作都相似，但是高容量外科医生与低容量外科医生之间以及经验丰富的外科医生与经验不足的外科医生之间存在细微但显著的差异。
病例系列，IV 级。
