Fowler TJ, Aquilina AL, Blom AW, Sayers A, Whitehouse MR. Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis.
BMJ Open 2021;
11:e047882. [PMID:
34758989 PMCID:
PMC8587578 DOI:
10.1136/bmjopen-2020-047882]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE
To investigate the association between surgeon grade (trainee vs consultant) and implant survival following primary hip and knee replacement.
DESIGN
A systematic review and meta-analysis of observational studies.
DATA SOURCES
MEDLINE and Embase from inception to 6 October 2021.
SETTING
Units performing primary hip and/or knee replacements since 1990.
PARTICIPANTS
Adult patients undergoing either a primary hip or knee replacement, predominantly for osteoarthritis.
INTERVENTION
Whether the surgeon recorded as performing the procedure was a trainee or not.
PRIMARY AND SECONDARY OUTCOME MEASURES
The 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.
RESULTS
Nine 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.
CONCLUSIONS
There 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 NUMBER
CRD42019150494.
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