Surgical training does not affect operative time and outcome in total knee arthroplasty

Abstract

Training the next generation of orthopaedic surgeons in total knee arthroplasty (TKA) is crucial, but might affect operative time and outcome. We hypothesized that the learning curve of residents in TKA has an impact on (1) operative time, (2) complication rates and (3) early postoperative outcome. In a retrospective analysis of 738 primary TKAs from our institutional joint registry, operative time, complication rates, patient-reported outcome measures (EQ-5D, WOMAC) within the first year and responder rates for positive outcome as defined by the OMERACT-OARSI criteria were compared between trainee and senior surgeons differentiating between conventional and navigated TKA. Mean operative time was 69.5±18.5min for trainees compared to 77.3±25.8min for senior surgeons (95%CI of the difference 1.5–13.9min, p = 0.02) in conventional TKA and 80.4±22.1min to 84.1±27.6min (95%CI of the difference -0.9–8.2min, p = 0.12) for navigated TKA, respectively. Intraoperative fracture (p≥0.36), thrombosis (p≥0.90), neurological deficits (p≥0.90) and infection rates (p≥0.28) were comparably low in both groups. Patient-reported outcome measures one year after TKA were similar for trainee and senior surgeons with EQ-5D 0.83±0.17 to 0.80±0.21 (p = 0.25) and WOMAC 74.85±18.60 to 72.77±20.12 (p = 0.44) for conventional TKA and EQ-5D 0.80±0.20 to 0.82±0.18 (p = 0.23) and WOMAC 72.71±18.52 to 75.77±17.78 (p = 0.07) for navigated TKA, respectively. Similarly, responder rates for positive outcome were comparable between trainees and senior surgeons (90.7% versus 87.0% p = 0.39 for conventional TKA, 88.7% versus 89.4% p = 0.80 for navigated TKA). Supervised TKA is a safe procedure during the learning curve of young orthopaedic surgeons.

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.…”

Fellow Involvement in Primary Total Knee Arthroplasty: Is There an “August Effect?”

“…Although the authors are unaware of any orthopedic studies evaluating the effect of only fellow involvement, there have been published studies on the effect of residents in arthroplasty. 11,13,14 Woolson and Kang compared 76 patients who underwent primary TKA without a fellow or resident to 60 patients who had a trainee involved in their surgery. The attending was scrubbed during the entirety of the cases with trainees, but the trainee performed about one-third to one-half of the procedure.…”

Early clinical outcome and learning curve following unilateral primary total knee arthroplasty after introduction of a novel total knee arthroplasty system

“…Appropriate surgical training in the new procedure could help resolve the inexpedient increase in time and blood loss, although Weber et al [ 14 ] found no significant differences in outcome between senior and trainee surgeons in TKA surgeries. Their study was, however, a retrospective study with a risk of selection bias, and all trainee surgeons had 2 years of surgical education prior to performing the surgery and were supervised throughout the operation by senior surgeons.…”