Abstract
Introduction
In 2009, surgeon error is a major factor contributing to premature failure in conventional arthroplasty. Technology has revolutionised quality control in all manufacturing industries, yet it has made little or no impact on practice in arthroplasty. Currently, no agreed standards exist—in either the UK or Australia— that allows us to state whether or not the operation was performed correctly.
In hip arthroplasty, acetabular orientation may be considered a non-controversial metric for assessing surgical precision in hip arthroplasty. We considered that a trained surgeon should be able to orientate the acetabular component within the safe zone 19 times out of 20.
Materials and methods
40 trainees at different stages in their training and 20 trained surgeons, (half of whom had performed over 1000 hip replacements) were assessed for their ability to orient an acetabular cup within the safe zone on three stations, one with the pelvis in the anatomic orientation, one with the pelvis in a distorted position, and one with the pelvis clad in a body preventing reliable palpation of landmarks and in a distorted position.
Their scores were compared to the standard we set, and to the scores of medical students using robotic technology to assist them.
Results
Less than 45% of the acetabular components oriented, even by trained surgeons, were in the safe zone when the pelvis was distorted from the anatomic position. Trainees were less precise, with the level of training being a significant factor predicting ability to orientate. Medical students who had never performed hip arthroplasty using robotic technology, obtained accurate results in 31/32 cases.
Conclusions
Trained surgeons in the UK are unable to achieve acetabular orientation within the safe zone reliably using clinical skills alone, while medical students can reliably achieve clinically important levels of accuracy immediately using technology. As we won the ashes, these observations are likely to hold true in Australia.
