Evaluating the learning curve of Minimally Invasive Chevron and Akin Osteotomy for correction of hallux valgus deformity: a systematic review.

Autor: Ramelli L; Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.; Division of Orthopaedic Surgery, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada, M5S 1B2., Ha J; Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.; Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada., Docter S; Division of Orthopaedic Surgery, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada, M5S 1B2., Jeyaseelan L; Barts Bone & Joint Health, Barts Health NHS Trust, London, UK., Halai M; Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.; Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada., Park SS; Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada. sam.park@wchospital.ca.; Division of Orthopaedic Surgery, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada, M5S 1B2. sam.park@wchospital.ca.
Jazyk: angličtina
Zdroj: BMC musculoskeletal disorders [BMC Musculoskelet Disord] 2024 Oct 26; Vol. 25 (1), pp. 854. Date of Electronic Publication: 2024 Oct 26.
DOI: 10.1186/s12891-024-07940-x
Abstrakt: Background: One procedure that has gained popularity in the surgical management of hallux valgus is the minimally invasive Chevron and Akin osteotomy (MICA). The purpose of this systematic review was to evaluate the learning curve associated with this technically demanding procedure.
Methods: A search of the EMBASE and PubMed databases was performed to identify all clinical studies that assessed the learning curve associated with the MICA procedure. Studies where patients were not diagnosed with hallux valgus, did not undergo MICA, or did not report data on operation time, fluoroscopy exposure, or complications were excluded. A risk of bias assessment was conducted to assess the validity of the studies.
Results: The initial literature search yielded 287 studies, and seven studies were included in the final analysis. A quantitative comparative analysis could not be performed as the included studies used different statistical methods to quantify the learning curve. Lewis et al. determined that after 38 operations, there was a decrease in operation time and fluoroscopy exposure (p < .001). Merc et al. found that it took 29 and 30 operations to reach a plateau for operation time and fluoroscopy exposure, respectively (p < .001). Palmanovich et al. found that it took 20 and 26 operations to reach a plateau for operation time and fluoroscopy exposure, respectively (p < .001). Toepfer and Strässle found there was a significant decrease in operation time and fluoroscopy exposure after the first 19 procedures in their series (p < .001). With respect to complications, one study found a significant difference after the 42nd operation (p = .007). However, the remaining studies found that complication rates did not significantly change with increased technical proficiency. All seven studies were deemed to have a moderate risk of bias.
Conclusions: Surgeons can expect a learning curve of 20 to 40 operations before reaching technical proficiency with the MICA procedure. After the learning curve is achieved, surgeons can expect to see a significant decrease in both operation times and fluoroscopy exposure. No consistent significant difference was found in complications as one becomes more technically proficient with the procedure.
(© 2024. The Author(s).)
Databáze: MEDLINE
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