Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Eur J Orthop Surg Traumatol. 2021 Oct;31(7):1297-1303. doi: 10.1007/s00590-021-02876-7. Epub 2021 Jan 22.
It is important to assess global trends in the practice of adult reconstruction orthopaedic surgery to understand how new evidence is being implemented. The International Society of Orthopaedic Centers (ISOC) is a consortium of academic orthopaedic centers whose members' practices likely reflect contemporary evidence and indicate how orthopaedic surgery residents and fellows are trained.
We administered a 65 question, electronic survey of adult reconstruction surgeons across the ISOC centers in September 2020 to assess practice patterns. Results were assessed using descriptive statistics or by modeling the underlying response distribution, and the analysis was stratified by hospital region.
79 surgeons across 19 ISOC centers in 5 continents (Asia, Australia, Europe, North America, South America) completed the survey. Selected findings include: in total hip arthroplasty (THA), the posterolateral approach was used for 71 ± 42% of THA (mean ± standard deviation) and the direct anterior approach in 18% ± 34%. In total knee arthroplasty, posterior-stabilized (66% ± 39%) and cruciate-retaining (19 ± 33%) implants were most common. Robots were available in 56% (44 of 79) of surgeons' centers more commonly in Asia, Australia, and North America. Tranexamic acid was routinely used in arthroplasty by 99% (78 of 79) of surgeons. Eighty-six percent (68 of 79) submit data to joint or other registries. Virtual visits were used for 13% ± 16% of outpatient visits and by 82% (64 of 79) of surgeons overall.
These findings may be of use now for surgeons to consider the practices of their peers at high-volume academic institutions, and in the future as we track temporal trends.
评估成人重建骨科手术实践的全球趋势很重要，以了解新证据是如何被实施的。国际骨科中心协会（ISOC）是一个由学术骨科中心组成的联盟，其成员的实践可能反映了当代的证据，并表明骨科住院医师和研究员是如何接受培训的。
我们于 2020 年 9 月向 ISOC 中心的成人重建外科医生进行了一项 65 个问题的电子调查，以评估实践模式。结果使用描述性统计或通过对基础响应分布进行建模来评估，分析按医院区域分层。
来自 5 大洲（亚洲、澳大利亚、欧洲、北美、南美）的 19 个 ISOC 中心的 79 名外科医生完成了这项调查。部分发现包括：在全髋关节置换术（THA）中，后外侧入路用于 71±42%的 THA（平均值±标准差），直接前入路用于 18%±34%。在全膝关节置换术中，后稳定（66%±39%）和保留交叉韧带（19%±33%）植入物最常见。机器人在 56%（44 名/79 名）的外科医生中心可用，更常见于亚洲、澳大利亚和北美。79 名外科医生中的 99%（78 名）常规在关节置换术中使用氨甲环酸。86%（68 名/79 名）的外科医生向关节或其他登记处提交数据。虚拟就诊用于 13%±16%的门诊就诊，79 名外科医生中有 82%（64 名）总体上使用。
这些发现现在可能对外科医生考虑高容量学术机构同行的实践有用，并在未来我们跟踪时间趋势时也有用。
