Background. For total hip arthroplasty (THA), cognitive training prior to performing real surgery may be an effective adjunct alongside simulation to shorten the learning curve. This study sought to create a cognitive training tool to perform direct anterior approach THA, validated by expert surgeons; and test its use as a training tool compared to conventional material. Methods. We employed a modified Delphi method with four expert surgeons from three international centres of excellence. Surgeons were independently observed performing THA before undergoing semi-structured cognitive task analysis (CTA) before completing successive rounds of electronic surveys until consensus. The agreed CTA was incorporated into a mobile and web-based platform. Forty surgical trainees (CT1-ST4) were randomised to CTA-training or a digital op-tech with surgical videos, before performing a simulated DAA THA in a validated fully-immersive virtual reality simulator. Results. Experts reached 100% consensus after five rounds. They defined THA in 46 steps and 52 decision points in 8 distinct procedural phases. Each phase comprised of a set of actions, cognitive demands, and critical errors and strategies. This CTA was mapped onto an open-access web-based learning tool [1]. Surgeons who prepared with CTA performed a simulated THA more efficiently (Time: 26 vs. 36 minutes and Procedural steps: 64 vs. 78), with fewer errors in instrument selection (22 vs 34 instances) and help required (6 vs. 19 instances), and with more accuracy (acetabular cup inclination error: 7° vs. 12°, anteversion error: 11° vs 19°) than those who prepared with conventional material. Discussion. This is the first validated CTA tool for arthroplasty. It provides structure for competency-based learning of this complex procedure. It is more effective at preparing orthopaedic trainees for a new procedure than conventional materials, for learning sequence, instrumentation and motor skills. Implications. Cognitive training combines education on decision making, knowledge and technical skill. It is a validated educational tool to upskill surgeons to perform hip arthroplasty and could replace current training and preparation methods for junior surgeons

Aims

The burden of revision total hip arthroplasty (rTHA) continues to grow. The surgery is complex and associated with significant costs. Regional rTHA networks have been proposed to improve outcomes and to reduce re-revisions, and therefore costs. The aim of this study was to accurately quantify the cost and reimbursement for a rTHA service, and to assess the financial impact of case complexity at a tertiary referral centre within the NHS.

Aims

The aim of this modified Delphi process was to create a structured Revision Hip Complexity Classification (RHCC) which can be used as a tool to help direct multidisciplinary team (MDT) discussions of complex cases in local or regional revision networks.