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Title: Implant alignment following total knee arthroplasty : a quality indicator for the intra-operative performance of the operating team
Author: Hadi, Mohammed
ISNI:       0000 0004 6423 4674
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2015
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Evidence of inadvertent patient harm due to healthcare staff errors - both within the NHS and in other healthcare providers worldwide - prompted regulator-led changes to eliminate such distressing incidents to patients and medical staff alike. Surgical disciplines, including orthopaedic surgery, became a focus of attention given the scale of the problem within operating theatres. Orthopaedic theatres are an example of a complex working environment that has been likened to an airplane cockpit whereby the delivery of unsafe and low quality service can lead to highly significant consequences. Around 32.6% of all surgical patient safety incidents reported by the NPSA are related to orthopaedics. Evidence suggests that harm incidents are influenced by the surgical team’s non-­‐technical skills, and can occur through an unpredicted combination of small, seemingly innocuous everyday events. It is also suggested that non-technical factors including the non-technical skills of the operating team can influence the technical tasks during surgery. In elective orthopaedic surgery, one important technical task during TKA surgery is achieving a neutral limb alignment making it a suitable surrogate for technical success and quality indicator for intra-operative performance. The impact of malalignment on patient outcomes is not fully understood. A systematic review of the literature demonstrated that although malalignment appears to associate with poor procedure outcomes however, the evidence in the literature to support this conclusion is subject to several limitations. There is also variability in the assessment methods qualities and a checklist to assess the radiological assessment methods is presented. Malalignment on the coronal plane is regarded as the most significant in determining long term implant survival. A novel X-­‐ray method using custom made jig and trigonometry principles designed during this thesis has demonstrated higher agreement with CT scan than the commonly used conventional short leg X-­‐rays in assessing coronal malalignment; (95% Limits of agreement = -­‐3.616867 to 3.616867 for novel technique versus -­‐6.333201 to 5.754254 for conventional short leg X-­‐rays). In order to explore the relationship between non-­‐technical factors and technical success, successive TKAs were observed to collect data on surgical team’s non-­‐ technical performance and the number of unwanted events. 3D malalignment was assessed using a low dose CT. Parson’s correlation and regression analysis showed that better overall limb alignment following TKA correlates significantly with better intra-­‐operative non-­‐technical skills measured using the Oxford NOTECHS II score (r=-­‐ 0.407, p=0.01), and not with eventless procedures (measured by the glitch count). The surgical teams’ non-­‐technical skills play a significant role in the team’s ability to carry out technical tasks. If we are to provide optimal patient care we need to invest in improving non-­‐technical skills in the theatre.
Supervisor: Not available Sponsor: University of Warwick
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA Public aspects of medicine