Identifying the learning curve for total ankle replacement using a mobile bearing prosthesis

Area of Science:

• Orthopedic Surgery
• Surgical Education
• Biomedical Engineering

Background:

• Total ankle arthroplasty (TAA) is a complex procedure where surgeon experience significantly impacts outcomes.
• A lack of consensus exists regarding the number of TAA cases required to achieve surgeon proficiency.
• This study investigates the learning curve for a specific TAA system.

Purpose of the Study:

• To determine the learning curve for total ankle arthroplasty (TAA) using a specific implant system.
• To identify the number of cases needed to achieve proficiency in TAA based on intraoperative and postoperative outcomes.
• To analyze the relationship between surgeon experience and patient outcomes in TAA.

Main Methods:

• The study analyzed data from the first 31 patients who underwent TAA.
• Intraoperative characteristics, postoperative complications, and clinical/radiological outcomes were assessed.
• The Moving Average Method was employed to determine learning curves for various outcomes.

Main Results:

• Operative time and intraoperative fracture risk decreased with experience, stabilizing after the 14th and 24th patients, respectively.
• Clinical outcomes (VAS, ROM, AOFAS) and radiological outcomes (tibio-talar ratio) stabilized after 11-28 cases.
• No significant learning curve was observed for SF-12 scores or specific angular measurements.

Conclusions:

• A distinct surgical learning curve exists for total ankle arthroplasty (TAA).
• Surgeon proficiency, marked by the stabilization of most operative, clinical, and radiological outcomes, is achieved after approximately 28 TAA cases.
• These findings provide a benchmark for TAA training and credentialing.