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What are the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

It was hypothesized that surgical time of beginners would be much longer than that of experts. Our purpose was to investigate and clarify the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty (TKA) as a multicentre study.

Methods

A total of 300 knees in 248 patients (averaged 74.6 years) were enrolled. All TKAs were done using the same instruments and the same measured resection technique at 14 facilities by 25 orthopaedic surgeons. Surgeons were divided into three surgeon groups (four experts, nine medium-volume surgeons and 12 beginners). The surgical technique was divided into five phases. Detailed surgical time and ratio of the time in each phase to overall surgical time were recorded and compared among the groups in each phase. A total of 62, 119, and 119 TKAs were done by beginners, medium-volume surgeons, and experts, respectively.

Results

Significant differences in surgical time among the groups were seen in each phase. Concerning the ratio of the time, experts and medium-volume surgeons seemed cautious in fixation of the permanent component compared to other phases. Interestingly, even in ratio, beginners and medium-volume surgeons took more time in exposure of soft tissue compared to experts. (0.14 in beginners, 0.13 in medium-volume surgeons, 0.11 in experts, P < 0.05).

Conclusion

Beginners took more time in exposure and closure of soft tissue compared to experts. Improvement in basic technique is essential to minimize surgical time among beginners. First of all, surgical instructors should teach basic techniques in primary TKA for beginners.

Level of evidence

Therapeutic studies, Level IV.

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Acknowledgments

The authors gratefully acknowledge the valuable contributions of Sumi Yamashita, RN, Koichi Horiuchi M.D., Yuki Kitta M.D., Masashi Okubo M.D., Ph.D., Hidenori Shimizu M.D., Kazuhiko Udagawa M.D., Shu Kobayashi M.D., Ph.D., Toshiki Kawasaki M.D., Ph.D., Kazuhiro Chiba, M.D., Ph.D., Yousuke, Kaneko M.D., Kenichiro Takeshima, M.D., Akira Wakita M.D., Yuki Takeda M.D., Yuji Kuroyanagi M.D., Ph.D., Hidejiro Kubota, M.D., Yukihiko Obara, M.D., Ph.D., Tatsuaki Matsumoto M.D., Masaki Nagashima M.D., Ph.D., Daiki Kaneko M.D., Ph.D., Ko Masumoto M.D., Ph.D., and Toshiro Otani M.D., Ph.D..

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki City, Kanagawa Prefecture, Japan

    Kengo Harato, Hidenori Tanikawa, Kazuya Kaneda & Yutaro Morishige

  2. Maeno Orthopedic Clinic, Matsuyama City, Ehime Prefecture, Japan

    Shinichi Maeno

  3. Department of Orthopedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama City, Kanagawa Prefecture, Japan

    So Nomoto

  4. Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Kengo Harato & Yasuo Niki

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  1. Kengo Harato
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  2. Shinichi Maeno
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  3. Hidenori Tanikawa
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  7. Yasuo Niki
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Correspondence to Kengo Harato.

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Harato, K., Maeno, S., Tanikawa, H. et al. What are the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc 24, 2704–2709 (2016). https://doi.org/10.1007/s00167-015-3554-3

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  • DOI: https://doi.org/10.1007/s00167-015-3554-3

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