A computerized bioskills system for surgical skills training in total knee replacement

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering
• Surgical Education

Background:

• Surgical skill is paramount in total knee replacement (TKR) outcomes.
• Traditional surgical training relies on an apprenticeship model with limited objective feedback.
• Objective assessment of technical accuracy in TKR is needed to improve surgical proficiency.

Purpose of the Study:

• To develop and demonstrate a computer-based system for quantitatively analyzing surgical errors in TKR.
• To assess the sources and magnitudes of errors in instrument alignment and their contribution to final component position and limb alignment.
• To identify specific procedural steps that significantly impact TKR outcomes.

Main Methods:

• A computer-based system using an infrared coordinate measurement system was employed.
• Twelve surgeons performed posterior-stabilized TKR on cadavers, with real-time measurement of instruments and components.
• Data analysis focused on the position, orientation, and alignment errors at each surgical step.

Main Results:

• Significant errors were observed in distal femur entry point localization and tibial tray rotational alignment.
• Imperfect balancing of flexion and extension gaps was common, with greater lateral opening and increased joint separation in flexion.
• The study identified discrete surgical steps as major contributors to final limb alignment and prosthetic knee laxity.

Conclusions:

• A computer-based system can quantitatively analyze TKR surgical technique and identify error sources.
• Objective feedback on technical accuracy can enhance surgical skills in TKR training.
• This method offers a risk-free approach to improving orthopedic surgical proficiency.