Assistant experience enhances the learning curve in reverse total shoulder arthroplasty: a comparative cumulative sum...

Area of Science:

• Orthopedic Surgery
• Surgical Education
• Biomedical Engineering

Background:

• Reverse total shoulder arthroplasty (rTSA) treats complex shoulder conditions like cuff tear arthropathy and osteoarthritis.
• Despite advancements, rTSA remains technically challenging, particularly for surgeons early in their practice.
• The role of assistant experience in mastering rTSA learning curves is not well understood.

Purpose of the Study:

• To evaluate the impact of prior assistant experience on the early learning curves of surgeons performing rTSA.
• To analyze operative time, blood loss, and complication rates in relation to assistant experience.
• To identify factors influencing the rate of proficiency acquisition in rTSA.

Main Methods:

• Retrospective analysis of the first 60 rTSA cases for three surgeons with varying assistant experience.
• Cumulative Summation (CUSUM) analysis of operative time to identify learning curve breakpoints.
• Assessment of intraoperative blood loss and perioperative complications across sequential case groups.

Main Results:

• Surgeons with prior assistant experience demonstrated earlier stabilization of operative time and reduced CUSUM elevation.
• Assistant experience under mature workflows led to the most rapid learning curve stabilization (15-20 cases).
• Reductions in blood loss and complication rates correlated with surgical experience, lagging slightly behind operative time stabilization.

Conclusions:

• Proficiency in rTSA is acquired stepwise and is significantly influenced by the quality of prior assistant experience.
• High-quality assistant training under experienced surgeons is crucial for optimizing the rTSA learning curve.
• Structured assistant experience can enhance perioperative safety and efficiency in reverse total shoulder arthroplasty.