Surgery performed by supervised registrars does not adversely affect medium-term functional outcomes after total knee replacement

Abstract

Introduction Although total knee arthroplasty (TKA) is an index procedure for orthopaedic registrars, there is a lack of published research as to the effects of surgery when performed by supervised trainees. The aim of this study was to compare functional outcomes up to five years after primary TKA performed by consultants and trainee surgeons. Methods A retrospective analysis was conducted of prospectively collected data for 609 consecutive patients (339 female, 270 male) undergoing TKA. Patients were assessed preoperatively as well as at 18 months, three years and five years postoperatively, and American Knee Society objective knee and functional scores (AKSK and AKSF) were recorded. Results Surgery was performed by a consultant in 465 cases and a supervised trainee in 144 cases. There were no significant differences between the two groups in preoperative patient characteristics, operative time (p=0.15), transfusion rates (p=0.84), length of stay (p=0.98), manipulation under anaesthesia (p=0.69), or mortality rates at one year (p=0.73) or five years (p=0.81). Postoperatively, the median magnitude of improvement in AKSK (48 points for consultant group vs 45 points for trainee group, p=0.74) and in AKSF (both groups 15, p=0.995) was similar between the groups. AKSK and AKSF scores were similar at all timepoints up to five years following surgery, and there was no difference in the median range of motion (both groups 100°, IQR: 18°) at five years (p=0.43). Conclusions TKA performed by supervised registrars gives functional outcomes that are equivalent to consultant performed TKA, without affecting postoperative range of movement, or increasing operative time, length of stay or transfusion rates. Rates of postoperative MUA and mortality are also comparable.

The Impact of Surgeon Volume and Training Status on Implant Alignment in Total Knee Arthroplasty

“…Given the divided nature of the existing literature, it is difficult to extrapolate the exact influence of surgeon volume and trainee status on the rate of malalignment in TKA. For example, results from studies assessing the impact of trainee surgeons and surgical experience on clinical outcomes following TKA and THA have demonstrated that neither experience nor trainee status significantly impacts outcomes [36][37][38][39] . However, similar studies assessing outcomes at U.S. Veterans Affairs (VA) training centers demonstrated mixed results 40,41 .…”

Outcomes and component-positioning in total knee arthroplasty may be comparable between supervised trained surgeons and their supervisor

“…Furthermore, they found that whether a consultant or trainee had performed the procedure had no significant effect on outcomes. Other similar studies have reported that outcomes may be comparable between trainees and supervisors when operations are performed under supervision or using a navigation system [19][20][21][22]. The major difference in our study was that we compared the outcomes of more and less experienced surgeons in the same patients without the use of a navigation system.…”

Trainee performed total knee arthroplasty is safe and effective: A systematic review and meta-analysis comparing outcomes between trainees and consultants

“…The presence of case mix and the differential complexity levels between the groups is in fact a reflection of the reality of surgical training, as trainees should only be performing procedures appropriate to their level of training, allowing effective training to be delivered without compromising patient safety. [9] There was a high degree of heterogeneity within the dataset, particularly with respect to surgical technique. A variety of different implants were used across the studies and both conventional and navigated techniques were included.…”

“…After exclusions, a total of nine studies were included in the final analysis [4,[8][9][10][11][12][13][14][15], involving 92,309 knee arthroplasties of which 80,655 were performed by consultants, and 11,654 performed by trainees (Table 1). One of the studies was a prospective randomised controlled trial, and eight were retrospective.…”