Woon Colin Y L, Carroll Kaitlin M, Lyman Stephen, Mayman David J
Hospital for Special Surgery, New York, NY, USA.
Arthroplast Today. 2019 Apr 11;5(2):202-210. doi: 10.1016/j.artd.2019.03.001. eCollection 2019 Jun.
Dynamic tibial tray sensors are playing an increasing role in total knee arthroplasty (TKA) coronal balancing. Sensor balance is proposed to lead to improved patient outcomes compared with sensor-unbalanced TKA, and traditional manual-balanced TKA. However, the "learning curve" of this technology is not known, and also whether sensor use can improve manual TKA balance skills once the sensor is taken away, effectively "training" the surgeon.
We conducted a single-surgeon prospective study on 104 consecutive TKAs. In Nonblinded Phase I (n = 49), sensor-directed releases were performed during trialing and final intercompartmental load was recorded. In Blinded Phase II (n = 55), manual-balanced TKA was performed and final sensor readings were recorded by a blinded observer after cementation. We used cumulative summation analysis and sequential probability ratio testing to analyze the surgeon learning curve in both phases.
In Nonblinded Phase I, sensor balance proficiency was attained most easily at 10°, followed by 90°, and most difficult to attain at 45° of flexion. In Blinded Phase II, manual balance was lost most quickly at 45°, followed by 90°, and preserved for longest at 10° of flexion. The number of cases in the steady state periods (early phase periods where there is a mix of sensor balance and sensor imbalance) for both phases is similar.
A surgeon who consistently uses the dynamic sensor demonstrates a learning curve with its use, and an "attrition" curve once it is removed. Consistent sensor balance is more predictable with constant sensor use.
动态胫骨托传感器在全膝关节置换术（TKA）的冠状面平衡中发挥着越来越重要的作用。与无传感器平衡的TKA和传统手动平衡的TKA相比，传感器平衡被认为能带来更好的患者预后。然而，这项技术的“学习曲线”尚不清楚，以及一旦移除传感器，使用传感器是否能提高手动TKA平衡技能，从而有效“训练”外科医生。
我们对连续104例TKA进行了单外科医生前瞻性研究。在非盲法第一阶段（n = 49），在试验过程中进行传感器引导的松解，并记录最终的关节间负荷。在盲法第二阶段（n = 55），进行手动平衡的TKA，并在骨水泥固定后由盲法观察者记录最终的传感器读数。我们使用累积求和分析和序贯概率比检验来分析两个阶段外科医生的学习曲线。
在非盲法第一阶段，在10°时最容易达到传感器平衡熟练程度，其次是90°，在屈曲45°时最难达到。在盲法第二阶段，在45°时手动平衡最快丧失，其次是90°，在屈曲10°时保持时间最长。两个阶段稳定期（传感器平衡和传感器不平衡混合的早期阶段）的病例数相似。
持续使用动态传感器的外科医生在使用时有一条学习曲线，移除传感器后有一条“损耗”曲线。持续使用传感器时，一致的传感器平衡更可预测。
