Learning curve in relation to radiation exposure, procedure duration and complications rate for Minimally Invasive...

Minimally invasive chevron Akin osteotomy (MICA) has become increasingly common and is compatible with the traditional open approaches for hallux valgus correction. However, it is impeded by concerns regarding the steep learning curve, increased radiation exposure and some specific complications. No standardized method for identifying a learning curve exists. We used a reproducible mathematical model to accurately define the learning curve of MICA with a focus on fluoroscopy time, procedure duration and complications rate.

We conducted a retrospective study of MICA procedure performed by a single surgeon during his initial experience with this procedure. The chronologic case number was plotted against variables of interest and learning was identified as the point at which instantaneous rate of change of a curve fit to the data set equalled the average rate of change of the data set.

One hundred cases have been analysed. Learning plateau in operation time was achieved after 29 cases, with the first 29 cases requiring a median of 60 min compared to 40 min for the latter 71 cases. Proficiency in fluoroscopy application occurred in case 30. The median fluoroscopy time for the first 30 cases was 86 seconds compared to 70 seconds in another 70 cases. The complication rate plateau was reached after 42 cases, with 15 of 22 complications occurring in the group operated first.

Results demonstrate surgeon's comfort with MICA to minimize operative time and radiation exposure after 30 cases. The plateau is achieved later for complications. Findings impose lag between surgeon feeling comfortable with procedure and a decrease in complications. Further research is reasonable to analyse several surgeons learning curve and to generate a potential reference learning curve that could serve as a normative.

UKC-MB-KME-33/19, retrospectively registered.