University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, Oxford, UK.
NIHR Oxford Biomedical Research Centre, The Joint Research Office, Oxford, UK.
Hip Int. 2023 May;33(3):411-419. doi: 10.1177/11207000211056864. Epub 2021 Nov 8.
Primary total hip arthroplasty (THA) is a commonly performed and successful operation which orthopaedic trainees must demonstrate competence in prior to completion of surgical training. An assessment of agreement between surgical trainers regarding the critical steps of a primary THA has never been undertaken. The aim of this study was to define and rank the key steps of a primary THA regards ease of teaching and their importance in achieving the best patient outcome.
The Delphi technique with 3 iterative rounds was used to establish expert group consensus. The benchmark for consensus was set at an 80% agreement in any category for each step of a THR. The intra-class correlation coefficient (ICC) was used to report on the inter- and intra-rater reliabilities between and within participants responses respectively in rounds 2 and 3.
50 consultant orthopaedic hip surgeons completed round 2, and 28 completed round 3. Overall, 27 steps (54 parameters) were identified, with 16 parameters achieving consensus agreement for their impact on patient outcome, and 17 for ease of teaching. The inter-rater ICC for patient outcome parameters was 0.89 and 0.92 in rounds 2 and 3 respectively while for teaching parameters it was 0.82 and 0.73. 50% of surgeons agreed that acetabular reaming, assessing and accurately restoring leg length, and acetabular cup anteversion were the 3 most difficult steps to teach trainees, while 90% agreed these 3 steps were substantially important to patient outcome. Another 5 steps achieved consensus for their substantial impact on patient outcome but failed to achieve consensus for ease of teaching.
The results of this expert consensus have produced a rank-order list of the key steps in primary THA, which may be used for orthopaedic curriculum development and guiding focused improvements for surgical training in primary THR including simulation.
初次全髋关节置换术（THA）是一种常见且成功的手术，骨科受训者在完成手术培训之前必须证明自己有能力完成该手术。此前从未对手术培训师在初次 THA 的关键步骤方面的一致性进行评估。本研究的目的是定义和排列初次 THA 的关键步骤，以评估其教学的容易程度及其对获得最佳患者结果的重要性。
使用 3 轮 Delphi 技术来建立专家小组的共识。共识的基准设定为在 THR 的任何步骤中，任何类别中有 80%的专家同意。使用组内相关系数（ICC）报告第 2 轮和第 3 轮中参与者之间和参与者内部的评分之间的可靠性。
50 名顾问骨科髋关节外科医生完成了第 2 轮，28 名完成了第 3 轮。总体而言，确定了 27 个步骤（54 个参数），其中 16 个参数在对患者结局的影响方面达成共识，17 个参数在教学方面达成共识。在第 2 轮和第 3 轮中，患者结局参数的组内相关系数 ICC 分别为 0.89 和 0.92，而在教学参数方面，ICC 分别为 0.82 和 0.73。50%的外科医生认为髋臼锉磨、评估和准确恢复下肢长度以及髋臼杯前倾角是最难教授受训者的 3 个步骤，而 90%的外科医生认为这 3 个步骤对患者结局至关重要。另外 5 个步骤在对患者结局有实质性影响方面达成共识，但在教学方面未能达成共识。
这项专家共识的结果产生了初次 THA 中关键步骤的排序，这可用于骨科课程开发，并指导初次 THR 的模拟教学等方面的有针对性的改进。
