title: Factors influencing the surgical process during shoulder joint replacement: time-action analysis of five different prostheses and three different approaches.
abstract: BACKGROUND
  To evaluate the per-operative process of shoulderjoint replacement, time-action analysis can be used.
  
  
  METHODS
  Forty procedures performed by 7 surgeons with different experience using 5 different prostheses and 3 different surgical approaches were analyzed.
  
  
  RESULTS
  The surgical procedures showed a large variation in, for example, duration, tasks of team members, and protocol used. The surgical procedure was influenced by several factors, such as the prosthesis used, the surgical approach, the patient's condition, and the experience of the surgeon. Exposure of the glenoid was difficult and several retractors were needed, which were held by an extra assistant or clamped to the table or the surgeon. Two main limitations were seen in all procedures: repeated actions and waiting. Also, five errors could be identified. None of the alignment instruments was completely reliable and they allowed the surgeon to make major errors.
  
  
  CONCLUSIONS
  Better alignment instruments, pre-operative planning techniques, and operation protocols are needed for shoulder prostheses. The training of resident surgeons should be focused on the exposure phase, the alignment of the humeral head, the exposure of the glenoid, and the alignment of the glenoid. Evaluating the surgical process using time-action analysis can be used to determine the limitations during surgical procedures. Furthermore, it shows the large variation in factors affecting surgical performance, indicating that a system approach is needed to improve surgical outcome.
authors.affiliation: Delft University of Technology, Faculty of Design, Engineering and Production, Delft, The Netherlands.
authors.forename: Joanne P J
authors.initials: JP
authors.lastname: Minekus
authors.forename: Edward R
authors.initials: ER
authors.lastname: Valstar
authors.forename: Piet M
authors.initials: PM
authors.lastname: Rozing
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: de Voss
authors.forename: Ron L
authors.initials: RL
authors.lastname: Diercks
authors.forename: W Jaap
authors.initials: WJ
authors.lastname: Willems
authors.forename: Jenny
authors.initials: J
authors.lastname: Dankelman
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods*; D002983:Clinical Competence; D019544:Equipment Failure Analysis; D006801:Humans; D007595:Joint Prosthesis; D019300:Medical Errors; D011183:Postoperative Complications / Q000209:etiology; D012785:Shoulder Joint / Q000601:surgery*