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Clinical
Orthopaedics & Related Research. 463:90-97, October 2007.
Cobb, Justin P FRCS; Kannan, Vijaraj MD; Brust, Klaus MD;
Thevendran, Gow MD
Abstract:
Hip resurfacing is a novel technique with a substantial
learning curve resulting in poor outcomes for many patients.
We asked whether navigation would influence this learning
curve and accuracy of implantation. Twenty medical students
earning their degree in surgical technology participated in
a randomized trial. We provided instruction about the
surgical technique, including the use of conventional
instrumentation, the use of a computed tomography-based
planner for hip resurfacing, and a navigation system. The 20
students were then split into three groups undertaking these
tasks in three different orders. Synthetic femurs replicated
normal, osteoarthritis, slipped capital femoral epiphysis,
and coxa valga. The mean error using the conventional method
to insert a guidewire was 23[degrees]; using the computed
tomography plan method it was 22[degrees]; and using
navigation was 7[degrees]. Students produced similar
accuracy, even in their first attempt, on difficult anatomy
when provided navigation. Motivated students rapidly
achieved an expert level of accuracy when provided with
navigation. Learning a conventional method first did not
improve performance, even in difficult cases. Our data
suggest navigation may play an important role in reducing
the learning curve in hip resurfacing arthroplasty and other
tasks in arthroplasty in which a high degree of accuracy is
clinically important.
(C) 2007 Lippincott Williams & Wilkins, Inc.
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