Butler Patrick, Gorgis Josef, Viberg Bjarke, Overgaard Søren
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Kolding, Denmark.
EFORT Open Rev. 2021 Jan 4;6(1):3-8. doi: 10.1302/2058-5241.6.200047. eCollection 2021 Jan.
When introducing an implant, surgeons are subjected to steep learning curves, which may lead to a heightened revision rate. Stepwise introduction revolutionized implant introduction but lacks a last step.No guidelines exist for the introduction of a well-documented implant not previously used in a department. This is problematic according to the European Union's legislated tendering process, potentially leading to increased revisions. In this systematic review, the introduction of a well-documented total hip arthroplasty implant to experienced surgeons is explored amid concerns of higher revision rate.Literature search strategies were deployed in the Embase and Medline databases, revealing a total of 14,612 articles. Using the Covidence software (Cochrane, London), two reviewers screened articles for inclusion.No articles were found that fulfilled our eligibility criteria. A post hoc analysis retrieved two national register-based studies only missing information about the surgeon's knowledge of the introduced implant. None of the introduced implants decreased the revision rate and around 30% of the introduced implants were associated with a higher revision rate.The review showed that no data exist about revision rates when introducing well-documented implants. In continuation thereof, the introduction of well-documented implants might also be associated with increased revision rates, as has been shown for total knee arthroplasty. We therefore suggest that special attention should be focused on changes of implants in departments, which can be achieved by way of specific registration in national registers. Cite this article: 2021;6:3-8. DOI: 10.1302/2058-5241.6.200047.
在植入物植入过程中，外科医生面临着陡峭的学习曲线，这可能导致翻修率升高。逐步引入法彻底改变了植入物的植入方式，但缺少最后一步。对于在某科室之前未使用过的、有充分文献记录的植入物的引入，目前尚无指南。根据欧盟法定的招标程序，这存在问题，可能导致翻修增加。在本系统评价中，探讨了在担心翻修率较高的情况下，向经验丰富的外科医生引入有充分文献记录的全髋关节置换植入物的情况。在Embase和Medline数据库中部署了文献检索策略，共检索到14612篇文章。使用Covidence软件（Cochrane，伦敦），两名评审员筛选文章以确定是否纳入。未发现符合我们纳入标准的文章。事后分析仅检索到两项基于国家登记册的研究，这些研究缺少关于外科医生对引入的植入物的了解的信息。没有一种引入的植入物降低了翻修率，约30%的引入植入物与较高的翻修率相关。该评价表明，在引入有充分文献记录的植入物时，不存在关于翻修率的数据。在此基础上继续来看，正如全膝关节置换术所示，引入有充分文献记录的植入物也可能与翻修率增加有关。因此，我们建议应特别关注科室中植入物的变化，这可以通过在国家登记册中进行特定登记来实现。引用本文：2021；6：3 - 8。DOI：10.1302/2058 - 5241.6.200047。
