IS THE QUALITY OF FEMORAL CEMENTATION IN CEMENTED TOTAL HIP REPLACEMENT CARRIED OUT BY SUPERVISED TRAINEES RADIOLOGICALY INFERIOR TO THOSE PERFORMED BY CONSULTANTS?

Abstract

Objective: The quality of femoral cementation is related with the long-term survival of hip prosthesis. We set out to identify if the quality of femoral cementing as assessed on the first postoperative AP radiograph was significantly different when operations performed by trainees were compared with those done by consultant staff.

The Barrack scoring system was used as a tool to evaluating cementation quality in all cases.

Material and Method: The cohort included 70 patients undergoing primary Exeter hip replacement. 41 cases were performed by consultants and 29 by trainees. The mean age of the consultant patients was 80 while in the second group this was 78. The ratio of “Funnel shaped” to “stove-pipe” femurs was 1/2.3 in the consultant group and 1/2.1 in trainees group. Thus the two groups were similar. The 1^st postoperative AP hip x-rays were numbered randomly and digital images were then graded using the method of Barrack by one observer (I.R) who was blinded to the seniority of surgeon.

Results: Of the total cohort of 70 patients, 35 (50%) were grade A, 28 (40%) grade B and 7 (10%) grade C. In the consultant cases 18(44%) were grade A, 19(46%) grade B and 4(10%) were grade C. The results in for training grade surgeons were 17 (58%) grade A, 9 (31%) grade B and 3 (11%) grade C. There were no grade D cases in either group. The standard deviation in consultant group was 23.46 while in case junior grade surgeons it was 25.46.

Conclusion: The results in this series of operations suggest that in our institution, the quality of femoral cementing was not significantly different when the operations carried out by consultants were compared to those where a trainee was the primary surgeon (p=0.087). As Barrack scores have been shown to correlate with the long term survival of hip arthroplasties, these results would suggest that patients undergoing operation undertaken by an adequately experienced and supervised trainee are not at increased risk for implant failure compared to the individuals where the Consultant is the primary surgeon.