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Key performance and training parameters in primary total hip arthroplasty - an expert consensus using the Delphi
Daniel Howgate1,2,3,4, Patrick Garfjeld Roberts1,2,3, Ben Kendrick1,3
1University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, Oxford, UK.
Summary
This study identified and ranked critical steps in primary total hip arthroplasty (THA) for surgical training. Key steps important for patient outcomes were also found to be challenging to teach trainees.
Area of Science:
- Orthopaedic Surgery
- Surgical Education
- Medical Training
Background:
- Primary total hip arthroplasty (THA) is a fundamental orthopaedic procedure.
- Competence in THA is essential for surgical trainees before completing their training.
- A consensus on the critical steps of THA for training purposes has been lacking.
Purpose of the Study:
- To define and rank the essential steps in primary total hip arthroplasty.
- To assess the ease of teaching for each critical step.
- To determine the importance of each step for achieving optimal patient outcomes.
Main Methods:
- The Delphi technique was employed over three iterative rounds to achieve expert consensus.
- A benchmark of 80% agreement was set for each step.
- Inter- and intra-rater reliability was assessed using the intra-class correlation coefficient (ICC).
Main Results:
- 27 steps and 54 parameters of primary THA were identified by 50 consultant orthopaedic hip surgeons.
- 16 parameters reached consensus for patient outcome importance, and 17 for ease of teaching.
- Acetabular reaming, leg length restoration, and acetabular cup anteversion were identified as crucial for outcomes and difficult to teach.
Conclusions:
- This expert consensus provides a ranked list of key primary THA steps.
- The findings can inform orthopaedic curriculum development and surgical training.
- Focused improvements, potentially including simulation, can be guided by this consensus for primary THA training.
