Sunday, December 2, 2012

A complication-based learning curve from 200 reverse shoulder arthroplasties. CORR

This is a very important article. It details the odyssey of an experienced shoulder surgeon to learn to do the reverse total shoulder. The concept of a learning curve is critical to every surgical procedure - how can individual surgeons achieve mastery? It is important to recognize that the learning curve is not only about surgical technique, but also about patient selection, in-hospital management, and rehabilitation.

As shown in the figure below from this article, experience is a great teacher. The rate of local complications was over 20% for the first 40 shoulders and less than 7% for the last 160 shoulders.

The most common complications were transient neuropathy, intraoperative fracture, postoperative dislocation, incompletely seated glenosphere, intraoperatively broken screw head, broken drill bit, chronic subluxation, acromion fatigue fracture, and painful cerclage wires.  Perioperative systemic complications occurred in 5% of the cases.

Part of the learning curve may be reflected in changes in the prosthesis selected. In this study all patients received a Grammont-style RTSA prosthesis, but between shoulders 16 and 25 the surgeon gradually transitioned from one manufacturer to another and between shoulders 73 and 160 there was another transition. Each prosthesis has its own learning curve.

This study brings to the fore the topic of surgeon experience and case volume. It has been shown that the quality of outcome is related to surgeon case volume. The explanation may like in the fact that low volume surgeons remain at the left hand side of the learning curve shown above.


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You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

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