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Introduction: Although the "learning curve" in surgical procedures is well recognized, littledata exists documenting the accuracy of surgeons in performing individual steps of orthopedicprocedures. In this study we have used a validated computer-based training system to measurevariations instrument placement and alignment in TKA, specifically those relating to tibialpreparation.Methods: Eleven trainees (surgical students, residents and fellows) were recruited to perform aseries of 43 knee replacement procedures in a computerized training center. After initialinstruction, each trainee performed a series of four TKA procedures in cadavers (n=2) and bonereplicas (n=2) using a contemporary TKA instrument set and the assistance of an experiencedsurgical instructor. The Computerized Bioskills system was utilized to monitor the placementand orientation of the proximal tibial osteotomy and the tibial tray.Results: The tibial component was implanted with an average posterior slope of 3.2°±2.7°. In14% of cases the tibial resection sloped anteriorly, and in another 5%, the posterior slopeexceeded 10°. In 83% of trials, the trainees cut the tibia with less posterior slope than intended,ranging from-10.0° to +5.6° (average:-2.0°±4.0°). The average rotational orientation of the tibial componentwas 5.4°±5.3°of external rotation, however individual values ranged from 7.6°of int rot to14.4°of ext rot. Overall, 19% of components were placed in internal rotation.Conclusions: Tibial preparation still presents significant difficulty to many less experiencedsurgeons, despite the use of modern instrumentation and careful didactic instruction. The errorsmeasured in the computerized bioskills lab unfortunately replicate clinical cases oftenpresenting with symptoms necessitating early revision,. Greater attention is needed to training ofsurgical skills and intraoperative assessment of component position to improve clinicaloutcomes of TKA.Friday, October 8, 2010, 7:30-8:30Session B9: Complications in ArthroplastyUsefulness of IBG With X-Changed Rim Mesh for Reconstruction of LargeTibial Bone Defect During TKA Procedure*Seiichi Ono - Shinonoi General Hospital - Nagano, Japan*Email: sgh_onos@grn.janis.or.jpThe objective of this study was to consider whether an impaction bone graft (IBG) with theirown bone tips surrounded with an X-changed rim mesh was useful when en bloc boneinplantation was not possible for a total knee replacement with large bone defect.file:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]