Total hip replacements (THRs) are performed by surgeons at various stages in their training, with varying levels of senior supervision. There is a balance between protecting training opportunities for the next generation of surgeons, while limiting the exposure of patients to unnecessary risk during the training process. The aim of this study was to examine the association between surgeon grade, the senior supervision of trainees, and the risk of revision following THR. We included 603 474 primary THRs recorded in the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man (NJR) between 2003 and 2016 for an indication of osteoarthritis. Exposures were the grade of the surgeon (consultant or trainee), and whether trainees were supervised by a scrubbed consultant or not. Outcomes were all-cause revision, the indication for revision, and the temporal variation in risk of revision (all up to 10 years). Net failure was calculated using Kaplan-Meier analysis and adjusted analyses used Cox regression and flexible parametric survival analysis (adjusted for patient, operative, and unit level factors). There was no association between surgeon grade and all-cause revision up to 10 years (crude hazard ratio (HR) 0·999, 95% confidence interval (CI) 0.936–1.065; p=0.966); a finding which persisted with adjusted analysis. Adjusted analysis demonstrated an association between trainees operating without supervision by a scrubbed consultant and an increase in all-cause revision (HR 1.100, 95% CI 1.002–1.207; p=0.045). There was an association between the trainee-performed THRs and revision due to instability (crude HR 1.143, 95% CI, 1.007–1.298; p=0.039). However, this was not observed in fully adjusted models, or when trainees were supervised by a scrubbed consultant. Within the current training system in the United Kingdom, trainees achieve comparable outcomes to consultant surgeons when supervised by a scrubbed consultant. Revision rates are higher when trainees are not supervised by a scrubbed consultant but remain within internationally recognised acceptable limits.
The aim of this study was to conduct evidence synthesis on the available published literature of the impact of the training status of the operating surgeon (trainee vs. consultant) on the survival and revision rate of primary hip and knee replacements. We conducted a systematic review according to Cochrane guidelines. Separate searches were performed for hip and knee replacements, with meta-analysis and presentation of results in parallel. We searched MEDLINE and Embase databases from inception to 17 September 2019 and included controlled trials and cohort studies reporting implant survival estimates, or revision rates of hip and knee replacements according to the grade of the operating surgeon. This study was registered with PROSPERO (CRD42019150494).Aims
Patients and Methods
The Sliding Hip Screw (SHS) is commonly used to treat trochanteric hip fractures. Fixation failure is a devastating complication requiring complex revision surgery. One mode of fixation failure is lag screw cut-out which is greatest in unstable fracture patterns and when the tip-apex distance of the lag screw is > 25 mm. The X-Bolt Dynamic Hip Plating System (X-Bolt Orthopaedics, Dublin, Ireland) is a new device which aims to reduce this risk of cut-out. However, some surgeons have reported difficulty minimising the tip-apex distance with subsequent concerns that this may lead to an increased risk of cut-out. We measured the tip-apex distance from the intra-operative radiographs of 93 unstable trochanteric hip fractures enrolled in a randomised controlled trial (Warwick Hip Trauma Evaluation, WHiTE One trial). Participants were treated with either the sliding hip screw or the X-Bolt dynamic hip plating system. We also recorded the incidence of cut-out in both groups, at a median follow-up time of 17 months.Objectives
Patients and Methods
