NAVIGATION SHORTENS HIP RESURFACING LEARNING CURVE

Abstract

Complications following hip resurfacing occur primarily because of the surgeon’s inability to achieve optimal implant positioning, and the significant learning curve associated with it. Our study sought to look at the impact of navigation technologies on this learning curve.

Twenty medical students doing their BSc project took part in the study. Four types of synthetic femurs were used for the study viz., Normal anatomy (11students), Osteoarthritis (5), Coxa Vara(2) and Coxa Valga(2). Each student was allowed to insert the guide wire according to their judgement in the femoral head using 3 systems: Conventional instrumentation, 3D plan based on a CT scan of the particular bone, helped by a conventional jig and Navigation system.

This achieved angle was then compared with the angle originally planned for each bone in all three groups using digitizing arm.

The range of error using the conventional method to insert a guide wire was 23deg (range −9 to 14, SD= 6.3), using the CT plan method, it was 22 deg (range −9 to 13, SD=6.6). Using the Navigation method it was 7 deg (range −5 to 2, SD=2.). Students who progressed from conventional through planning to navigation (group 1) were no more accurate than students who went straight to navigation without ever having used conventional instrumentation (group 3). Students produced similar accuracy even in their maiden attempt, on difficult anatomy when provided with navigation technology.

This study has shown that motivated and enthusiastic students can achieve an expert level of accuracy very rapidly when provided with the appropriate level of technology. he development of surgeons who are able to deliver excellent outcomes depends more on technology than training.