Negligible effect of surgeon experience on the accuracy and time to perform unrestricted caliper verified kinematically aligned TKA with manual instruments

PURPOSE: Surgeons performing total knee arthroplasty (TKA) are interested in the accuracy and time it takes to make the four femoral resections that determine the setting of the femoral component. A method for quantifying the error of each resection is the thickness, measured by a caliper, minus the femoral target. The present study tested the hypothesis that the mean deviation of the resection from the femoral target, the percentage of resections with a deviation of ± 0.5, 1.0, 1.5, and 2.0 mm, and the time to complete the femoral cuts were not different between experienced (E) and less-experienced (LE) surgeons performing unrestricted caliper verified kinematically aligned (KA) TKA with manual instruments. METHODS: This study analyzed intraoperative verification worksheets from 203 patients treated by ten E surgeons and 58 patients treated by four LE surgeons. The worksheet recorded (1) the thickness of the femoral target for the distal medial (DM), distal lateral (DL), posterior medial (PM), and posterior lateral (PL) resections and the caliper thickness of the resections with a resolution of 0.5 mm, and (2) the time to complete them. The most accurate resection has a mean difference ± standard deviation of 0 ± 0.0 mm. RESULTS: The accuracy of the 1044 initial resections (261 patients) was significantly closer to the femoral target for E vs. the LE surgeons: 0.0 ± 0.4 vs. - 0.3 ± 0.5 for the DM, 0.0 ± 0.5 vs. - 0.4 ± 0.6 for the DL, - 0.1 ± 0.5 vs. - 0.2 ± 0.5 PM, and - 0.1 ± 0.5 vs. - 0.4 ± 0.6 for the PL resections (p ≤ 0.0248). E surgeons completed the femoral resections in 12 min; 5 min faster than LE surgeons (p < 0.0001). CONCLUSIONS: Because the mean difference in femoral resections with manual instruments for E vs. LE surgeons was < 0.5 mm which is within the caliper's resolution, differences in accuracy were not clinically relevant. Surgeons exploring other alignment options and robotic, navigation, and patient-specific instrumentation might find these values helpful when deciding to change. LEVEL OF EVIDENCE: III; case-control study.