Abstract
There has been limited research examining the effect training of orthopaedic trainees may have on patient outcomes. This paper aims to determine if there is a difference in revision rate and functional outcomes of total hip joint replacement performed by consultants compared to those performed by supervised and unsupervised trainees.
We reviewed all patient data since 2000 from the New Zealand National Joint Registry in patients undergoing total hip joint replacement (THJR) comparing the outcomes with the experience of the primary surgeon. The outcome measures were revision hip replacement and the Oxford Hip score at six months. We compared the reason for revision controlling for factors such as ASA, age and the index diagnosis. We also compared the six-month Oxford scores with the experience of the primary surgeon.
There were 35415 patients who underwent elective THJR, 30344 of which were performed by a consultant, 2982 by a supervised registrar and 1067 by an unsupervised registrar. There was an overall revision rate (RR) of 0.77 per 100 component years. The RR was 0.75 (95% CI 0.67–0.82) for consultants, 0.97 (95% CI 0.72 – 1.28) for supervised trainees and 0.70 (95% CI 0.36 – 1.22) for unsupervised trainees. There was no significant difference in revision rates between consultants and supervised trainees (p<0.077) or unsupervised trainees (p< 0.30). The most common cause for revision surgery was dislocation, occurring in 39% of cases. This was more common in supervised and unsupervised trainees (48% and 50%) however there was no significant difference between the three groups (p-value 0.24). The other causes for revision were; loosening of the acetabular or femoral component, deep infection, pain and fracture with no significant difference between the three groups. The mean OHS was higher for consultants at 40.7 compared to 38.95 and 38.23 for supervised and unsupervised trainees respectively (p <0.001)
The results of this study show no significant difference in the revision rate of THJR performed by trainees when compared to their consultants. Orthopaedic consultants do appear to have slightly better (1–2 points) OHS. These results are reassuring and show orthopaedic training does not adversely compromise patient outcomes.
