Optimising performance of hip arthroplasty
Research type
Research Study
Full title
Understanding variation and improving training using Observation Clinical Human Reliability Analysis (OCHRA) and Virtual Reality (VR)
IRAS ID
271845
Contact name
Justin Cobb
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
3 years, 0 months, 2 days
Research summary
Total hip arthroplasty (THA) is one of the most frequently performed and successful operations in orthopaedics. Around 100,000 THA's are performed in the UK annually. It is well known that THA surgery has excellent outcomes in most patients, however there is still variation in performance between surgeons. Complication rates have been reported as high as 10% and the link between surgeon volume and complication risk has been well established with a 30% increased risk reported for early complications in surgeons performing less than 35 THA operations each year.
The ‘Getting it Right First Time’ (GIRFT) initiative reported that nearly a quarter (24%) of THA surgeons in the UK performed <10 operations per year, which may be putting patients at higher risk. In this study we will apply the use of Observational Clinical Human Reliability Analysis (OCHRA) to videos of surgeons performing THA surgery. This will help us understand error & variation in clinical practice allowing us to standardise technique.
Furthermore, the majority of THA procedures in the UK are performed through an open surgical posterior approach (PA) according to data from the national joint registry. Strong evidence now exists that the Direct Anterior Approach (DAA) is safer and less invasive, allowing significantly faster recovery and return to independence compared with other approaches. Unfortunately, the learning curve is considerable and many established PA surgeons find transitioning to the DAA technique challenging. This has already demonstrated safe results, comparable to those with inpatient stays with equal outcomes. Furthermore, outpatient THA costs around 30% less. The main issue is tackling problems associated with the steep learning curve.
In this study we will apply lessons learned from the OCHRA error analysis to developing our cutting-edge virtual reality simulator to see if this can flatten this steep learning curve making operations safer & more reliable.
REC name
London - Bromley Research Ethics Committee
REC reference
20/LO/0432
Date of REC Opinion
23 Apr 2020
REC opinion
Further Information Favourable Opinion