The learning curve of third-generation percutaneous chevron and Akin osteotomy (PECA) for hallux valgus

T. Lewis, P.W Robinson, R. Ray, T.AJ Goff, P.MC Dearden, M.R Whitehouse, P. Lam, G. Dracopoulos

Background: The learning curve to reach technical proficiency for third- generation percutaneous or minimally invasive chevron and Akin osteotomies (PECA/MICA) is recognised to be technically challenging however it is poorly defined in the literature. 

Methods: Retrospective review of the first 58 consecutive PECA cases of a single surgeon. The primary outcome was the number of cases required to reach technical proficiency as defined by the tourniquet time. Secondary outcomes included radiation exposure, radiographic deformity and complication rates. 

Results: Between November 2017 and March 2019, 61 consecutive PECA cases were performed with outcome data available for 58 of these (95.1%). Technical proficiency was reached after 38 cases. Tourniquet time and radiation exposure significantly decreased after this transition point (p<0.05). There was no difference in complication rate or radiographic deformity correction regardless of position along the learning curve (p>0.05). 

Conclusion: The mean number of cases required to reach technical proficiency in third-generation PECA is 38 cases. The complication rate does not correlate to the number of cases performed, therefore surgeons interested in learning minimally invasive surgery can be reassured that they are unlikely to cause additional risk of harm to a patient during the learning curve. This information is useful to inform the consent process.