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

Abstract

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.

A systematic review and meta-analysis of trainee- versus consultant surgeon-performed elective total hip arthroplasty

“…One study reported outcomes following minimally invasive THA. 15 Dates of publication for included studies ranged from 2004 to 2017. All studies were performed in developed-world settings, with four British, one German, one North American and two Australasian studies.…”

Complications after direct anterior versus Watson-Jones approach in total hip arthroplasty: results from a matched pair analysis on 1408 patients

“…The difference is due to a higher complication rate of minimal complications, such as a simple urinary tract infection [25] or a slight hypokalemia [26]. A far more important finding is the similar rate of surgical complications, especially considering other studies mostly favor standard approaches [16, 20], regardless of the presence of the learning curve [27]. The lack of differences between the two groups suggests that experienced surgeons have a low fracture rate altogether, regardless of the approach [20, 28, 29].…”

A prospective randomized comparison of the minimally invasive direct anterior and the transgluteal approach for primary total hip arthroplasty

“…The demand for minimally invasive hip arthroplasty is continuously increasing [ 15 ]. Literature provides evidence for a decreased intra-operative blood loss, lower postoperative pain levels and a shorter recovery time in case of minimally invasive surgery [ 3 – 5 ].…”