LEARNING CURVE IN PONSETI METHOD - EVOLUTION IN 5 YEAR-INTERVALS

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics

Background:

• Idiopathic clubfoot is a common congenital foot deformity.
• The Ponseti method is the gold standard for treating idiopathic clubfoot, involving serial casting.
• Optimizing treatment efficiency and outcomes is crucial for patient management.

Purpose of the Study:

• To evaluate the impact of surgeon experience on the duration and efficiency of the Ponseti method for idiopathic clubfoot.
• To assess if increased surgeon expertise correlates with a reduced number of cast changes.
• To analyze the evolution of the Pirani Score in relation to surgeon experience.

Main Methods:

• A comparative study was conducted across two reference centers with varying levels of surgeon experience (mentor vs. trainee).
• Data from 254 patients (403 feet) at Institution 1 (mentor) and 32 patients (51 feet) at Institution 2 (trainee) were analyzed.
• Institution 1 data was divided into three 5-year intervals representing accumulating experience, while Institution 2 data covered one 5-year interval.

Main Results:

• Patients treated by the experienced mentor required significantly fewer casts than those treated by the trainee (p < 0.001).
• At Institution 1, significant differences in cast numbers were observed across the three 5-year intervals (p < 0.05), with the earliest interval showing the highest average cast number (3.47).
• The Pirani Score demonstrated the most significant decrease between the first and third clinic visits in both institutions.

Conclusions:

• Greater surgeon expertise in the Ponseti method is associated with a reduction in the number of cast applications and treatment time for idiopathic clubfoot.
• The benefits of enhanced surgical experience appear most pronounced in the initial years of practice.
• The Pirani Score's progression indicates that optimal correction is typically achieved by the third cast application.