Does Orthopaedic Training Compromise the Outcome in Knee Joint Arthroplasty?

Storey, Richard Norman; Frampton, Chris; Kieser, David; Ailabouni, Ramez; Hooper, Gary J.

doi:10.1016/j.jsurg.2018.02.011

Cited by 15 publications

(13 citation statements)

References 16 publications

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“…This may mean that there is no difference, or that appropriate case mix selection and supervision of trainees is currently employed and is safe to continue. Our results are concordant with published registry data, 32 33 and represent the best available evidence, but are limited by the quality of the existing published studies.…”

Section: Discussionsupporting

confidence: 87%

“…Our findings are consistent with those of the New Zealand Joint Registry. 32 33 In a cohort of 35 415 THRs, of which 4049 were performed by trainees, the authors reported no significant difference in the revision rate between surgeon groups. 33 In a further cohort of 79 671 TKRs and 8854 UKRs, of which approximately 10% were performed by trainees, they reported no significant difference in the revision rates of knee replacements performed by trainees and consultants.…”

Section: Discussionmentioning

confidence: 96%

“… 33 In a further cohort of 79 671 TKRs and 8854 UKRs, of which approximately 10% were performed by trainees, they reported no significant difference in the revision rates of knee replacements performed by trainees and consultants. 32 These studies were not included in this meta-analysis because the authors did not report net survival estimates and revision rates were reported ‘per 100 component years’, rather than for clearly defined periods of follow-up, which cannot be calculated from the data presented.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…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.…”

Section: Eligible Studiesmentioning

confidence: 99%

“…11,400 (97.8%) of knee arthroplasties within the trainee group were performed under supervision of consultant surgeons. Two studies reported outcomes following unicompartmental knee arthroplasty [12,15]. One study compared outcomes in computer navigated TKA [10] whilst another compared outcomes between computer navigated and conventional TKA [4] (Table 2).…”

Section: Eligible Studiesmentioning

confidence: 99%