Comparative learning curves for early complications in anatomical and reverse shoulder arthroplasty

Abstract

Introduction There has been a significant increase in the implantation of reverse shoulder replacements over anatomical shoulder replacements in the past five years. Few comparative data exist comparing early complication rates and learning curves. This study aimed to evaluate the early complication rates and learning curves of a single surgeon series of anatomical and reverse shoulder replacements over the first five years of independent practice. Materials and methods The first 100 anatomical and 100 reverse shoulder replacements performed between July 2011 and July 2016 were reviewed to identify early complications. Cumulative sum plots were used to analyse the learning-curve effect. Results Early complications were noted in 4 anatomical and 17 reverse shoulder replacements. One of the anatomical and ten of the reverse shoulder replacements required a return to theatre within three months. The early complication rates were observed to be significantly higher in the reverse shoulder replacement group compared with the anatomical shoulder replacement group (odds ratio 4.9; 95% confidence interval 1.6-15.2, P 1/4 0.057). An inflection point on the anatomical shoulder replacement cumulative sum plot suggestive of a trend to consistent performance was reached at 16 cases. No inflection point was observed on the reverse shoulder replacement cohort. Conclusions We observed a significantly higher early complication rate within the reverse shoulder replacement cohort, with a tenfold increase in early reoperations. In comparison to the trend seen after 16 cases for anatomical shoulder replacement, no trend was seen in the reverse shoulder replacement cohort. This either reflects the higher complication rate seen in reverse shoulder replacement or that the learning curve extends beyond 100 cases, highlighting the need for extended performance monitoring.

Effectiveness of Immersive Virtual Reality on Orthopedic Surgical Skills and Knowledge Acquisition Among Senior Surgical Residents

“…Figure 4 demonstrates the effects of ToT on early learning curves. 13 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 The cost incurred for IVR training was considered a function of biweekly use on a US $4800.00 per year cost, equaling US $46.15/session. The cost of traditional training was considered the cost incurred to an individual for course registration and travel and was approximated as US $2000.00.…”

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

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Complications and Intraoperative Fractures in Reverse Shoulder Arthroplasty: A Systematic Review

“…Forty-six studies 15,46,66,69,119-134,134–157 reported a total of 188 intraoperative fractures (IFx) among the complications, representing a global IFx rate of 1.4%.…”

“…However, it remains a difficult procedure and high rates of complications are still being reported. 134…”

“…However, it remains a difficult procedure and high rates of complications are still being reported. 134 By excluding any study focused on single specific complications or outcomes, we tried to give our review the most accurate possible design to evaluate the real complication rate.…”