Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis

Abstract

ObjectiveTo investigate the association between surgeon grade (trainee vs consultant) and implant survival following primary hip and knee replacement.DesignA systematic review and meta-analysis of observational studies.Data sourcesMEDLINE and Embase from inception to 6 October 2021.SettingUnits performing primary hip and/or knee replacements since 1990.ParticipantsAdult patients undergoing either a primary hip or knee replacement, predominantly for osteoarthritis.InterventionWhether the surgeon recorded as performing the procedure was a trainee or not.Primary and secondary outcome measuresThe primary outcome was net implant survival reported as a Kaplan-Meier survival estimate. The secondary outcome was crude revision rate. Both outcomes were reported according to surgeon grade.ResultsNine cohort studies capturing 4066 total hip replacements (THRs), 936 total knee replacements (TKRs) and 1357 unicompartmental knee replacements (UKRs) were included (5 THR studies, 2 TKR studies and 2 UKR studies). The pooled net implant survival estimates for THRs at 5 years were 97.9% (95% CI 96.6% to 99.2%) for trainees and 98.1% (95% CI 97.1% to 99.2%) for consultants. The relative risk of revision of THRs at 5 and 10 years was 0.88 (95% CI 0.46 to 1.70) and 0.68 (95% CI 0.37 to 1.26), respectively. For TKRs, the net implant survival estimates at 10 years were 96.2% (95% CI 94.0% to 98.4%) for trainees and 95.1% (95% CI 93.0% to 97.2%) for consultants. We report a narrative summary of UKR outcomes.ConclusionsThere is no strong evidence in the existing literature that trainee surgeons have worse outcomes compared with consultants, in terms of the net survival or crude revision rate of hip and knee replacements at 5–10 years follow-up. These findings are limited by the quality of the existing published data and are applicable to countries with established orthopaedic training programmes.PROSPERO registration numberCRD42019150494.

First-time revision knee arthroplasty using a hinged prosthesis

“…Previous studies have shown that the training grade does not influence the revision risk following primary TKA. 30 This study suggests that does not seem to be the case following revision surgery with a HKA and that a consultant grade surgeon should be involved in the surgery.…”

A Multi‐factor Analysis of Revision in Total Hip Replacement Using the Collarless‐Polished‐Tapered Stems with Different Cups

“…The reason might be the patient's condition of the Trainee Surgeons were less complicated than the Consultant Surgeons. There was no evidence to prove that Trainees had worse postoperative outcomes than Consultants by comparing the survival years and revision rates in the existing literature 20 …”

“…There was no evidence to prove that Trainees had worse postoperative outcomes than Consultants by comparing the survival years and revision rates in the existing literature. 20 …”

“…There was no evidence to prove that Trainees had worse postoperative outcomes than Consultants by comparing the survival years and revision rates in the existing literature. 20 Figure 13 shows that stainless steel had the best postoperation results as the survival trend was higher than other groups (P < 0.001). Although research by Hwang et al was related to a dual-mobility cup, the results also indicate that the cup size was smaller and the rate of dislocation lower.…”