Surgical Education of Eccentric Rotational Acetabular Osteotomy for HIP Trainees

Amano, Toyoki; Hasegawa, Yukiharu; Kawasaki, Masashi; Yao, Jin; Seki, Tomohiro; Ishiguro, Naoki

doi:10.5301/hipint.5000314

Cited by 3 publications

(5 citation statements)

References 29 publications

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“…Simultaneously, it would be crucial to teach the technique of OT. Hence, we are currently trying to establish a learning center [32]. Because advanced surgical technique is required to perform the osteotomy, the facilities where surgeons can perform osteotomies are limited.…”

Section: Discussionmentioning

confidence: 99%

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Surgery trends for osteonecrosis of the femoral head: a fifteen-year multi-centre study in Japan

Kaneko

Takegami

Seki

et al. 2020

International Orthopaedics (SICOT)

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Purpose The most appropriate procedure and at what type and stage of osteonecrosis of the femoral head (ONFH) these procedures had been argued. We attempted to clarify the trend in surgical operations with respect to the age of patients, type classification, and stage of ONFH over a period of 15 years by using the multi-center sentinel monitoring system in Japan. Methods We evaluated the hips of 3844 patients using this system in three phases of every five years from 2003 to 2017. We classified the surgical procedures as osteotomy (OT), hemiarthroplasty (Hemi), and total hip arthroplasty (THA). We assessed the trend in age, type classification, and stage of ONFH over three time periods; "early," and the "late." We calculated the proportion of surgeries for ONFH in each period. We used the Cochran-Armitage test to evaluate trends in proportion of two levels of characteristics across three time periods. Results The proportion of younger patients significantly decreased. The proportion of OT and Hemi decreased over time, while the proportion of THA increased. The proportion of patients with types C1 and C2 who underwent OT and Hemi decreased over time. In contrast, that of THA increased. The proportion of patients who underwent OT and Hemi significantly decreased; the proportion of patients who underwent THA significantly increased over time at all stages. Conclusions In Japan, the younger patients underwent surgery for ONFH decreased. The patients who underwent OT and Hemi for ONFH decreased, while that of THA increased over time.Keywords Osteonecrosis of the femoral head . Temporal trends . A multi-centre hospital-based sentinel monitoring system . Type . Stage

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Section: Discussionmentioning

confidence: 99%

“…Because advanced surgical technique is required to perform the osteotomy, the facilities where surgeons can perform osteotomies are limited. Surgical education for OT technique is more difficult than that for THA [32]. Therefore, trainees are taught at major facilities where surgeons regularly perform osteotomies.…”

Section: Discussionmentioning

confidence: 99%

Surgery trends for osteonecrosis of the femoral head: a fifteen-year multi-centre study in Japan

Kaneko

Takegami

Seki

et al. 2020

International Orthopaedics (SICOT)

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“…Education is possible in this regard, with 1 study demonstrating satisfactory postoperative clinical outcomes when comparing trainees to instructors for a similar intervention 21 . While this study indicates that rotation is a teachable skill, it called for more effort into education on the subject to prevent complications.…”

Section: Discussionmentioning

confidence: 91%

“…20 Education is possible in this regard, with 1 study demonstrating satisfactory postoperative clinical outcomes when comparing trainees to instructors for a similar intervention. 21 While this study indicates that rotation is a teachable skill, it called for more effort into education on the subject to prevent complications. Our study is in good agreement with the literature, as results of the inter-modality analysis indicate that although nonsurgeon subjects start out with relatively more accuracy with the Kirschner wires (Fig.…”

Section: Discussionmentioning

confidence: 92%

Eye of the Carpenter: How Well do Orthopaedic Surgeons Estimate Angular Measurements in Derotational Osteotomies?

Chaclas,

Dyer,

Mayers

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Femoral derotational osteotomies are used by orthopaedic surgeons to decrease version in a variety of pathologies. Intraoperatively, the goal of the surgery is to decrease the rotation of the femur to within physiological range. Surgeons generally visually estimate the angle of correction based on bone markers at the rotating cylindrical portion of the femur. This study sought first to assess the accuracy and inter-rater reliability of surgeons with respect to angle creation, and then to implement a training intervention. Methods: A rotational femur model was constructed and tested among surgeons and nonsurgeons. Surgeons were then randomized into an experimental and control cohort with training on the model as the intervention. Subjects were asked to create target angles of 15, 30, 45, and 60 degrees using only Kirschner wires and then only bone marks for reference. Independent and paired t-tests were performed to determine variability between cohorts. Results: The mean angle creation error and range of the surgeon cohort were significantly lower than those of the nonsurgeon cohort. Within the nonsurgeon cohort, the mean angle creation error and range of the wire modality were significantly lower than that of the mark modality. The mean angle creation error and range of the trained cohort were significantly lower than the untrained cohort. Conclusions: The considerable inter-subject range within the surgeon cohort highlights a need for the reinforcement of basic geometric principles within orthopaedic instruction. This model allows for immediate, accurate feedback on angle creation, and training appears to be both time and cost-effective. The physiological range allows for a level of variability between surgical outcomes without consequence. However, the more than 20 degree range determined by this study does not fall within those bounds and should be addressed. Clinical Relevance: Moving forward, rotational estimation as a surgical skill should increase in prominence within orthopaedic instruction to maximize future joint health, and additional emphasis should be placed on fundamental spatial orientation during training.

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“…Education is possible in this regard, with one study demonstrating satisfactory postoperative clinical outcomes when comparing trainees to instructors for a similar intervention [17]. While this study indicates that rotation is a teachable skill, it called for more effort into education on the subject to prevent complications.…”

Section: Discussionmentioning

confidence: 97%

Eye of the Carpenter: How Well do Orthopaedic Surgery Residents and Faculty Estimate Angular Measurements in Derotational Osteotomies?

Chaclas

Wheatley

Grandizio

et al. 2022

Preprint

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BACKGROUND Femoral derotational osteotomies are used by Orthopaedic surgeons to decrease anteversion in a variety of pathologies. Intraoperatively, the goal of the surgery is to decrease the rotation of the femur to within physiologic range. Surgeons generally visually estimate the angle of correction based off bone markers at the rotating cylindrical portion of the femur. This study sought to assess the inter-subject reliability between subjects and modalities with respect to alpha angle creation. METHODS A rotational femur model was constructed and tested amongst undergraduates, medical students, surgical residents and attendings. Subjects were asked to create angles of 15, 30, 45, and 60 degrees using only Kirschner wires and then only bone marks for reference. Two-tailed independent t-tests were performed to determine variability between cohorts, and effect size was calculated for significant results. RESULTS The participants were split into two cohorts: undergraduates and medical students in the ‘non-surgeon’ cohort, and surgical residents and attendings in the ‘surgeon’ cohort. The overall average angle creation error of the surgeon cohort was significantly lower than the non-surgeon cohort. The average angle creation range across all modalities and angles created was significantly lower in the surgeon cohort when compared to the non-surgeon cohort. The non-surgeon cohort was significantly more accurate with the wire modality as compared to the mark modality. The surgeon cohort had no significant difference in inter-modality average error. CONCLUSIONS The considerable inter-subject range within the surgeon cohort highlights a need for reinforcement of basic geometric principles within orthopaedic instruction. This model allows for immediate accurate feedback on angle creation. The physiologic range allows for a degree of variability between surgical outcomes without consequence. However, the more than twenty-degree range determined by this study does not fall within those bounds and should be addressed. Moving forward, rotational estimation as a surgical skill should increase in prominence within orthopaedic instruction, and additional emphasis should be placed on fundamental spatial orientation during training.

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Surgical Education of Eccentric Rotational Acetabular Osteotomy for HIP Trainees

Cited by 3 publications

References 29 publications

Surgery trends for osteonecrosis of the femoral head: a fifteen-year multi-centre study in Japan

Surgery trends for osteonecrosis of the femoral head: a fifteen-year multi-centre study in Japan

Eye of the Carpenter: How Well do Orthopaedic Surgeons Estimate Angular Measurements in Derotational Osteotomies?

Eye of the Carpenter: How Well do Orthopaedic Surgery Residents and Faculty Estimate Angular Measurements in Derotational Osteotomies?

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