2015 ISAKOS Biennial Congress ePoster #101
Arthroscopic Ankle Arthrodesis: The Learning Curve
Kosuke Yamamoto, MD, Hiroshima JAPAN
Ichiro Yoshimura, MD, PhD, Fukuoka, Fukuoka JAPAN
Kazuki Kanazawa, MD, Fukuoka JAPAN
Masatoshi Naito, MD, Fukuoka City, Fukuoka JAPAN
Faculty of Medicine, Fukuoka University, Fukuoka, JAPAN
FDA Status Cleared
Summary: This graphic representation of the AAAT and JSSF score by case number generated a learning curve in which learning was shown as a decrease in the operative time and an increase in the JSSF score as surgical experience was gained.
Arthroscopic ankle arthrodesis (AAA) have been an established technique for end-stage ankle arthritis. However, AAA remains a technically demanding and not easy procedure. We hypothesized that as surgical experience increases, learning can effect the operative time and clinical outcome. The purpose of this study was to investigate the learning curve of AAA.
?Methods?we retrospective reviewed the consecutive 82 AAA performed from 2005 to 2013 by a single surgeon beginning with his first case. The AAA procedure was consist of three 3 steps; 1. the subchondral bone was denuded from all the articular surfaces using a abrader bar to expose bleeding cancellous bone. 2. the ankle was positioned correctly in neutral. 3. Under image intensifier control, cannulated screws were placed. The AAA time was defined the duration of time in minutes from the initiation of arthroscopic ankle arthrodesis to completion of the arthrodesis. We evaluated surgical outcomes as measured by the Japanese Society for Surgery of the Foot (JSSF) score. Learning was graphically represented by plotting the AAA time and JSSF score by case number and then generating a logarithmic trend curve. A best-fit number linear equation (y = ax + b) allowed for comparison of the slope, which represented the rate of change in the AAA time and JSSF score (x represented case number, y represented the AAA time or JSSF score, and a represented the slope).
?Results? The AAA time significantly decreased and the JSSF score significantly improved (P < 0.05 for both). The slope (a) of the line fitting all cases for the AAA time was -0.002 (stage IIIb, -0.003; stage IV, -0.002). The slope (a) of the line fitting all cases for the JSSF score was +0.001 (stage IIIb, +0.001; stage IV, +0.001).
?Conclusions? This graphic representation of the AAA time and JSSF score by case number generated a learning curve in which learning was shown as a decrease in the operative time and an increase in the JSSF score as surgical experience was gained. AAA is associated with good clinical outcomes, but there is a learning curve that we estimate to be approximately forty cases.