[Medical device training in arthroplasty : National practice and quality standards]. / Medizinprodukteschulungen in der Endoprothetik : Nationale Praxis und Qualitätsansprüche.

The qualified training of users of medicinal products is enshrined in law by the Medical Devices Act. In this article, a survey and analysis of the training measures for arthroplasty of the large joints offered by distributors of medical devices is carried out. To that end, the internet presence of suppliers of medical devices was evaluated with regard to the training measures on offer, and selected suppliers were sent questionnaires. The presentation of the available training programmes on the websites was incomplete. Even after the amendment of the Medical Devices Act, this has only slightly changed; however, legally required instructions for use were available for all distributors questioned. In some cases, there are large gaps in the range of modern training methods on offer, such as practical instruction, multimedia offerings or visual-haptic training methods.

The arthroscopic Latarjet: a multisurgeon learning curve analysis.

BACKGROUND: The open Latarjet procedure is a standard surgical treatment option for anterior shoulder instability in patients with a high risk of failure following soft tissue stabilization. The arthroscopic technique has potential advantages of minimal invasiveness, reduced postoperative stiffness, and faster rehabilitation but is regarded as technically challenging with concern over surgical risk during the learning curve. The aim of this study was to undertake a multisurgeon, large-volume learning curve analysis of the arthroscopic Latarjet procedure using continuous learning curve analysis. METHODS: Individual patient data from 12 surgeons across 5 countries were retrospectively reviewed. A total of 573 patients undergoing the arthroscopic Latarjet procedure were included. Outcome measures of learning were collected, including operative time, computed tomography (CT) bone-block positioning, complications, and patient-reported outcome measures (PROMs). A segmented linear regression modeling technique was used for learning curve analysis. RESULTS: High-volume surgeons converged to an operative time steady state after 30-50 cases. Surgeons completing fewer procedures demonstrated a constant reduction in operative time without reaching a plateau. Low-volume surgeons completing fewer than 14 operations did not demonstrate a reduction in operative time. Accuracy of bone-block positioning on postoperative CT demonstrated constant improvement without reaching a plateau after 53 cases. There was no change in PROMs or complications with increased operative volume. CONCLUSION: Specialist shoulder surgeons require 30-50 arthroscopic Latarjet procedures to attain steady-state operative efficiency, during which there is improvement in bone-block positioning. Only surgeons expecting to undertake the arthroscopic Latarjet in high volume should consider adopting this procedure.

Open mHealth Architecture: A Primer for Tomorrow's Orthopedic Surgeon and Introduction to Its Use in Lower Extremity Arthroplasty.

BACKGROUND: The recent private-public partnership to unlock and utilize all available health data has large-scale implications for public health and personalized medicine, especially within orthopedics. Today, consumer based technologies such as smartphones and "wearables" store tremendous amounts of personal health data (known as "mHealth") that, when processed and contextualized, have the potential to open new windows of insight for the orthopedic surgeon about their patients. METHODS: In the present report, the landscape, role, and future technical considerations of mHealth and open architecture are defined with particular examples in lower extremity arthroplasty. RESULTS: A limitation of the current mHealth landscape is the fragmentation and lack of interconnectivity between the myriad of available apps. The importance behind the currently lacking open mHealth architecture is underscored by the offer of improved research, increased workflow efficiency, and value capture for the orthopedic surgeon. CONCLUSION: There exists an opportunity to leverage existing mobile health data for orthopaedic surgeons, particularly those specializing in lower extremity arthroplasty, by transforming patient small data into insightful big data through the implementation of "open" architecture that affords universal data standards and a global interconnected network.

Evaluation of the learning curve for reverse shoulder arthroplasty.

This purpose of this study was to quantify the surgical learning curve and provide guidelines to surgeons interested in teaching and performing reverse shoulder replacement. Sixty-two consecutive primary reverse shoulder replacements performed by a single surgeon were retrospectively reviewed. Using data from consecutive cases, surgical time was plotted against patient case order, and the linear regression slope was calculated. Case length slope analysis demonstrated a significantly negative slope with the first 18 cases, which subsequently leveled thereafter. The number of cases needed to arrive at this flat slope was defined as the proficiency point.The proficiency point was then verified using the measurable variables of baseplate screw number and glenosphere overhang by dividing the series into 2 groups: Group A included patients who had surgery prior to the proficiency point, and group B included patients who had surgery after the proficiency point. In group A, only 33% (6/18) had all 4 glenoid baseplate screws placed as compared to 66% (29/44) in group B (P=.02). Glenosphere overhang increased from a mean of 1.02 mm (+/-1.29 mm) in group A to 2.58 mm (+/-1.89 mm) in group B (P=.003).A learning curve of approximately 18 cases was found in this series based on the technical aspects of performing reverse shoulder replacement. This curve is likely even longer for lower volume shoulder surgeons. We recommend specialized training prior to performing this procedure.

A virtual-reality training system for knee arthroscopic surgery.

Surgical training systems based on virtual-reality (VR) simulation techniques offer a cost-effective and efficient alternative to traditional training methods. This paper describes a VR system for training arthroscopic knee surgery. Virtual models used in this system are constructed from the Visual Human Project dataset. Our system simulates soft tissue deformation with topological change in real-time using finite-element analysis. To offer realistic tactile feedback, we build a tailor-made force feedback hardware.

Supplemental clinical dissections for freshman gross anatomy.

This paper describes a series of nine short clinically oriented dissection exercises as supplements for freshman gross anatomy courses. These procedures heighten and focus student interest, and they do not extensively lengthen the time required to accomplish the regular dissection assignments. The exercises are: lumbar puncture, anterior approach for shoulder arthroplasty, acromioclavicular dislocation, fenestration of the diaphragm, appendectomy, cholecystectomy, display of the facial nerve as in parotidectomy, posterior approach for hip arthroplasty, and injuries to the knee ligaments and meniscectomy.