What are the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty?
OBJECTIVE
It was hypothesized that surgical time of beginners would be much longer than that of experts. Our purpose was to investigate and clarify the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty (TKA) as a multicentre study.


METHODS
A total of 300 knees in 248 patients (averaged 74.6 years) were enrolled. All TKAs were done using the same instruments and the same measured resection technique at 14 facilities by 25 orthopaedic surgeons. Surgeons were divided into three surgeon groups (four experts, nine medium-volume surgeons and 12 beginners). The surgical technique was divided into five phases. Detailed surgical time and ratio of the time in each phase to overall surgical time were recorded and compared among the groups in each phase. A total of 62, 119, and 119 TKAs were done by beginners, medium-volume surgeons, and experts, respectively.


RESULTS
Significant differences in surgical time among the groups were seen in each phase. Concerning the ratio of the time, experts and medium-volume surgeons seemed cautious in fixation of the permanent component compared to other phases. Interestingly, even in ratio, beginners and medium-volume surgeons took more time in exposure of soft tissue compared to experts. (0.14 in beginners, 0.13 in medium-volume surgeons, 0.11 in experts, P < 0.05).


CONCLUSIONS
Beginners took more time in exposure and closure of soft tissue compared to experts. Improvement in basic technique is essential to minimize surgical time among beginners. First of all, surgical instructors should teach basic techniques in primary TKA for beginners.


METHODS
Therapeutic studies, Level IV.
Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki City, Kanagawa Prefecture, Japan. kharatoh@yahoo.co.jp.|Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. kharatoh@yahoo.co.jp.
Kengo
K
Harato
Maeno Orthopedic Clinic, Matsuyama City, Ehime Prefecture, Japan.
Shinichi
S
Maeno
Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki City, Kanagawa Prefecture, Japan.
Hidenori
H
Tanikawa
Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki City, Kanagawa Prefecture, Japan.
Kazuya
K
Kaneda
Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki City, Kanagawa Prefecture, Japan.
Yutaro
Y
Morishige
Department of Orthopedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama City, Kanagawa Prefecture, Japan.
So
S
Nomoto
Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Yasuo
Y
Niki
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000193:education / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D061646:Operative Time; D011446:Prospective Studies
Basic technique; Beginners; Education; Surgical time; Total knee arthroplasty