Do trainee surgeons have an adverse effect on the outcome after total hip arthroplasty?

Reidy, Michael; Faulkner, Alastair; Shitole, B; Clift, Benedict A.

doi:10.1302/0301-620x.98b3.35997

Cited by 32 publications

(28 citation statements)

References 13 publications

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“…Both groups showed excellent improvement within the first year. The results are similar to previous published one-year results after THA 8, 24 . Accordingly, responders as defined by the OMERACT-OARSI criteria 20 were not significantly different in relation to the surgical experience with a responder rate of over 90% in both groups.…”

Section: Discussionsupporting

confidence: 92%

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Trainee Surgeons Affect Operative Time but not Outcome in Minimally Invasive Total Hip Arthroplasty

Weber¹,

Benditz²,

Woerner³

et al. 2017

Sci Rep

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Training of young surgeons in total hip arthroplasty (THA) is crucial, but might affect operative time and outcome especially in minimally invasive (MIS) THA. We asked whether the learning curve of orthopaedic residents trained on MIS THA has an impact on (1) operative time (2) complication rates and (3) early postoperative outcome. In a retrospective analysis of over 1000 MIS THAs from our institutional joint registry, operative time, complication rates, patient reported outcome measures (Western Ontario and McMaster Universities Arthritis Index [WOMAC] and Euro-Qol 5D-5L [EQ-5D]) within the first year and responder rates for positive outcome as defined by the Outcome Measures in Rheumatology and Osteoarthritis Research Society International consensus responder (OMERACT-OARSI) criteria were compared between trainee and senior surgeons. Mean operative time was nine minutes longer for trainees compared to senior surgeons (78.1 ± 25.4 min versus 69.3 ± 23.8 min, p < 0.001). Dislocation (p = 0.21), intraoperative fracture (p = 0.84) and infection rates (p = 0.58) were comparably low in both groups. Both trainee and senior THAs showed excellent improvement of EQ-5D (0.34 ± 0.26 versus 0.32 ± 0.23, p = 0.40) and WOMAC (45.9 ± 22.1 versus 44.9 ± 20.0, p = 0.51) within the first year after surgery without clinical relevant differences. Similarly, responder rates for positive outcome were comparable between trainees with 92.9% and senior surgeons with 95.2% (p = 0.17). MIS THA seems to be a safe procedure during the learning curve of young orthopaedic specialists, but requires higher operative time.

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Section: Discussionsupporting

confidence: 92%

“…However, two different approaches were used in this study - (a) anterolateral, and (b) posterior. In addition, the study reported that a total of 1.5% of the patients developed deep wound infections within the period of ten years after THA 8 . In our study, the overall infection rate after one year of THA was 0.6%.…”

Section: Discussionmentioning

confidence: 99%

Trainee Surgeons Affect Operative Time but not Outcome in Minimally Invasive Total Hip Arthroplasty

Weber¹,

Benditz²,

Woerner³

et al. 2017

Sci Rep

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“…Second, surgery in public hospitals is often performed by trainee surgeons who may be expected to have a higher rate of revision and this may explain the lower rates of TKR revision in private hospitals when matched for prostheses. Previous research, however, has not shown a higher rate of arthroplasty revision among trainee surgeons …”

Section: Discussionmentioning

confidence: 82%

“…Previous research, however, has not shown a higher rate of arthroplasty revision among trainee surgeons. 8,9 Third, expectations and demands of private patients may differ from public patients. Combined with greater access to care (not just access to consultants and private hospitals, but greater ability to take time off work and arrange for carers), this may increase the rate of revision in the private sector.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of hip and knee replacement surgery in private and public hospitals in Australia

Harris

Cuthbert

Lorimer

et al. 2019

ANZ Journal of Surgery

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Background This study determined the contributing factors of hospital sector (private versus public) variation in revision rates after elective total hip replacement (THR) for hip fracture, and elective total knee replacement (TKR). Methods Using data from a large national arthroplasty registry, funnel plots for hospitals were generated, displaying the proportion of revised primary procedures. The proportion of outliers for each distribution was defined as the proportion outside the upper 99.7% confidence limit. Survival analyses determined differences between hospital sector revision rates separately for implants with the lowest revision rate, and for all other implants. Multivariate Cox regression determined the role of hospital sector in revision, adjusting for possible confounders. Results For THR performed for osteoarthritis, 17.4% of private and 4.4% of public hospitals were outliers. For TKR performed for osteoarthritis, 19.6% of private and 10.0% of public hospitals were outliers. For THR for fractured neck of femur, 8.1% of private and 0.0% of public hospitals were outliers. Adjusted and unadjusted Kaplan–Meier analyses showed higher THR revision rates in private hospitals for osteoarthritis and fractured neck of femur, but no difference when restricted to the 10 prostheses with the lowest revision rate. The Kaplan–Meier analysis of TKR showed higher revision rates for private hospitals, with the association reversing when restricted to prostheses with the lowest revision rate. Conclusions Considerable variation was seen in the revision rate after THR and TKR between hospital sectors in Australia. The variation was largely due to differences in prosthesis selection.

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“…Although previous studies have evaluated the impact of surgeon grade on the long-term outcome of total hip 20,21 and total knee arthroplasty, 22 to our knowledge, this is the first study which attempts to evaluate the long-term outcome of UKAs performed by trainees. In keeping with the aforementioned studies, our findings suggest that with appropriate training and supervision, trainee surgeons can achieve similar results to experienced consultants during UKA.…”

Section: Discussionmentioning

confidence: 99%

A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty

Bottomley

Jones

Rout

et al. 2016

The Bone & Joint Journal

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AimsThe aim of this to study was to compare the previously unreported long-term survival outcome of the Oxford medial unicompartmental knee arthroplasty (UKA) performed by trainee surgeons and consultants. Patients and MethodsWe therefore identified a previously unreported cohort of 1084 knees in 947 patients who had a UKA inserted for anteromedial knee arthritis by consultants and surgeons in training, at a tertiary arthroplasty centre and performed survival analysis on the group with revision as the endpoint.ResultsThe ten-year cumulative survival rate for revision or exchange of any part of the prosthetic components was 93.2% (95% confidence interval (CI) 86.1 to 100, number at risk 45). Consultant surgeons had a nine-year cumulative survival rate of 93.9% (95% CI 90.2 to 97.6, number at risk 16). Trainee surgeons had a cumulative nine-year survival rate of 93.0% (95% CI 90.3 to 95.7, number at risk 35). Although there was no differences in implant survival between consultants and trainees (p = 0.30), there was a difference in failure pattern whereby all re-operations performed for bearing dislocation (n = 7), occurred in the trainee group. This accounted for 0.6% of the entire cohort and 15% of the re-operations. ConclusionThis is the largest single series of the Oxford UKA ever reported and demonstrates that good results can be achieved by a heterogeneous group of surgeons, including trainees, if performed within a high-volume centre with considerable experience with the procedure.Cite this article: Bone Joint J 2016;(10 Suppl B):22–7.

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Do trainee surgeons have an adverse effect on the outcome after total hip arthroplasty?

Abstract: This study suggests that when trainees are appropriately supervised, they can obtain results comparable with those of their consultant colleagues when performing THA.

Cited by 32 publications

References 13 publications

Trainee Surgeons Affect Operative Time but not Outcome in Minimally Invasive Total Hip Arthroplasty

Trainee Surgeons Affect Operative Time but not Outcome in Minimally Invasive Total Hip Arthroplasty

Outcomes of hip and knee replacement surgery in private and public hospitals in Australia

A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty

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