Learning Curve In The Use Of Navigation In Computer Assisted Total Knee Arthroplasty. Comparing Novice And Expert Performance Results

Learning curve remains one of the issues in the use of navigation in computer assisted total knee arthroplasty (TKA). We compared in this study two homogeneous series of 50 patients performed by two surgeons working in the same hospital's team. One of the surgeons was beginner, so-called novice, and the other one was expert in navigation. The study compared over the same period of time, the anatomical results, operation times and the number of complications between the two surgeons. Apart from the operation time which increased in approximately 10 minutes on average for the surgeon novice (Experienced surgeon/Novice surgeon = 73 vs 92 mn; p<0.001), no significant differences was found in the final anatomical results between the two surgeons with more than 99% of the prostheses aligned within the 3 recommended degrees. Operation time between the novice and the expert surgeons becomes equivalent after 20 TKA without compromising neither the anatomical result nor the risks incurred to the patients. This study confirms the effectiveness of navigation in TKA and shows that a surgeon beginner can be accustomed rather quickly to this technique without risk for the patients or himself. We discuss in this study the ergonomic aspect of the technique and the adoption of this technology by majority of orthopedic surgeons.