Knee Surg Relat Res.  2018 Dec;30(4):303-310. 10.5792/ksrr.17.064.

The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method

• Lee DK
• Kim KK
• Ham CU
• Yun ST
• Kim BK
• Oh KJ

• KMID: 2438110
• DOI: http://doi.org/10.5792/ksrr.17.064

Abstract

PURPOSE
The purpose of this study was to investigate whether surgical experience could improve surgical competency in medial open wedge high tibial osteotomy (MOWHTO).
MATERIALS AND METHODS
One hundred consecutive cases of MOWHTO were performed with preoperative planning using the Miniaci method. Surgical errors were defined as under- or overcorrection, excessive posterior slope change, or the presence of a lateral hinge fracture. Each of these treatment failures was separately evaluated using the cumulative summation test for learning curve (LC-CUSUM).
RESULTS
The LC-CUSUM showed competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture after 27, 47, and 42 procedures, respectively. However, the LC-CUSUM did not signal achievement of competency in prevention of overcorrection after 100 procedures. Furthermore, the failure rate for overcorrection showed an increasing tendency as surgical experience increased.
CONCLUSIONS
Surgical experience may improve the surgeon's competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture. However, it may not help reduce the incidence of overcorrection even after performance of 100 cases of MOWHTO over a period of 6 years.

Keyword

Knee; Osteoarthritis; Osteotomy; Accuracy; Learning curve

MeSH Terms

Incidence
Knee
Learning Curve*
Learning*
Medical Errors
Methods*
Osteoarthritis
Osteotomy*
Treatment Failure