In this retrospective study we evaluated the
proficiency of shelf autograft in the restoration of bone stock
as part of primary total hip replacement (THR) for hip dysplasia,
and in the results of revision arthroplasty after failure of the primary
arthroplasty. Of 146 dysplastic hips treated by THR and a shelf
graft, 43 were revised at an average of 156 months, 34 of which
were suitable for this study (seven hips were excluded because of
insufficient bone-stock data and two hips were excluded because
allograft was used in the primary THR). The acetabular bone stock
of the hips was assessed during revision surgery. The mean implant–bone
contact was 58% (50% to 70%) at primary THR and 78% (40% to 100%)
at the time of the revision, which was a significant improvement
(p <
0.001). At primary THR all hips had had a segmental acetabular
defect >
30%, whereas only five (15%) had significant segmental
bone defects requiring structural support at the time of revision.
In 15 hips (44%) no bone graft or metal augments were used during
revision. A total of 30 hips were eligible for the survival study. At a
mean follow-up of 103 months (27 to 228), two aseptic and two septic
failures had occurred. Kaplan-Meier survival analysis of the revision
procedures demonstrated a ten-year survival rate of 93.3% (95% confidence
interval (CI) 78 to 107) with clinical or radiological failure as
the endpoint. The mean Oxford hip score was 38.7 (26 to 46) for
non-revised cases at final follow-up. Our results indicate that the use of shelf autografts during
THR for dysplastic hips restores bone stock, contributing to the
favourable survival of the revision arthroplasty should the primary
procedure fail. Cite this article:
Surgical training is based on an apprenticeship model. This training can be divided broadly into three main categories: practical skills, knowledge and decision making. The operating room is the nexus of a large part of surgical teaching. The supervising surgeon imparts both practical teaching as well as didactic information to the trainee during surgical procedures. A large amount of decision making skills are also acquired in the OR. Indeed, a large part of the surgical teams time is spent in the operating room which makes it an ideal educational environment. Bench model training is one teaching modality whereby the novice surgeon is taught surgical skills on life-like models. This practice enhances and accelerates the ability of the trainee to acquire fundamental, technical and surgical skills in the operating room. Whether bench model training provides an advantage on the ability of the trainee to acquire knowledge and decision making skills is unknown. Based on the motor learning theories, it is hypothesized that bench-model training will allow junior residents to be more interactive than trainees lacking similar active hands-on training. In this study, we examined whether bench model training provides an advantage on the ability of the trainee to acquire knowledge and decision making skills. 30 junior surgical residents from various surgical divisions, with minimal knowledge of technical, procedural and cognitive skills related to the ulna bone fixation (primary task), were recruited in this study. 15 residents, randomly assigned, were given instructions and the benefit of practice on a bench model, and 15 were given instructions but not the chance to practice the skill on a bench model. All residents, while tested for their accuracy and time taken for ulna fixation (secondary task, decision making skills), were also verbally taught information on different aspects of primary bone healing. This information was evaluated by a multiple-choice test (knowledge acquisition).Purpose
Method