CASCO Piede e Caviglia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
University of Southern California, Keck School of Medicine, Los Angeles, CA, United States.
Foot Ankle Surg. 2021 Feb;27(2):129-137. doi: 10.1016/j.fas.2020.03.005. Epub 2020 Mar 16.
Total ankle arthroplasty is an increasingly effective option for the treatment of end-stage arthritis. One recent innovation utilizes a transfibular, lateral approach. Like any new system, there is likely a learning curve associated with its use. We analyzed a series of patients who received a total ankle arthroplasty via a transfibular approach to state if it is possible to identify and to evaluate effects of a learning curve in the use of this novel total ankle replacement system.
76 consecutive patients meeting inclusion and exclusion criteria were retrospectively analyzed. All patients had a minimum of 24 months of follow-up. Intraoperative parameters, preoperative and postoperative subjective outcome scores, radiographic parameters, and complications were recorded and evaluated.
There were significant learning curve effects on various surgical and postoperative parameters. Surgical time decreased with the curve stabilizing after the 16th patient. With regard to patient outcomes, a learning curve was identified for the VAS, AOFAS, and SF-12 MCS scores. The number of patients required to stabilize these curves were 21, 13, and 16, respectively. Alignment as measured by alpha and gamma angles also improved with experience, with the curves stabilizing at 18 and 15 patients, respectively. There was a larger number cases required for complication rates, with the curve stabilizing after the 39th patient. No significant learning curve was found for ankle ROM, SF-12 PCS, beta angle, tibio-talar ratio (TTR), or tibio-talar surface angle (TTS).
This study demonstrates a significant learning curve with respect to operative time, patient outcomes, and radiographic parameters. Extrapolating this information, we urge surgeons to adequately familiarize themselves with any new implant through a training program in a high-volume center.
IV, case series.
全踝关节置换术是治疗终末期关节炎的一种越来越有效的选择。最近的一项创新采用经腓骨外侧入路。像任何新系统一样，其使用可能存在学习曲线。我们分析了一系列接受经腓骨全踝关节置换术的患者，以确定是否可以识别并评估该新型全踝关节置换系统使用中的学习曲线的影响。
回顾性分析符合纳入和排除标准的 76 例连续患者。所有患者均随访至少 24 个月。记录并评估术中参数、术前和术后主观结果评分、影像学参数和并发症。
各种手术和术后参数都存在明显的学习曲线效应。手术时间随着第 16 例患者后曲线稳定而减少。就患者结果而言，VAS、AOFAS 和 SF-12 MCS 评分均存在学习曲线。分别需要 21、13 和 16 例患者来稳定这些曲线。通过 alpha 和 gamma 角测量的对齐也随着经验的增加而改善，分别在第 18 例和第 15 例患者后曲线稳定。并发症发生率需要更多的病例，在第 39 例患者后曲线稳定。踝关节 ROM、SF-12 PCS、beta 角、胫距比（TTR）或胫距面角（TTS）没有明显的学习曲线。
本研究表明，手术时间、患者结果和影像学参数方面存在显著的学习曲线。根据这些信息推断，我们敦促外科医生通过在高容量中心进行培训计划来充分熟悉任何新植入物。
IV，病例系列。
