Abstract
PurposeThere are concerns that malalignment in total knee arthroplasty (TKA) occurs with less experienced surgeons. This study investigates the influence of surgical experience on TKA outcomes.Materials and methodsNineteen patients (38 knees) who underwent bilateral TKA between 2011 and 2015 were included. A supervisor performed knee replacements associated with lower Knee Society Scores (KSS); trainee surgeons operated on the other knee. Knees were categorized into two groups: operations by the supervisor (group S) versus operations by trainee surgeons (group T). Range of motion (ROM), KSS, operative time, hip–knee–ankle angle, and femoral and tibial component angle were evaluated.ResultsThe mean operative time was 92.5 min in group S and 124.2 min in group T (p < 0.01). The mean postoperative maximal flexion was 113.2° in group S and 114.2° in group T (not significant). The mean postoperative KSS was 92.9 in group S and 93.9 in group T (not significant). No significant differences between groups in terms of proportion of inliers for the hip–knee–ankle angle, femoral component angle, or tibial component angle were observed.ConclusionsAlthough operative time was significantly longer for trainee surgeons versus the supervisor, no significant differences in ROM, KSS, or component positioning between supervisor and trainee surgeons were observed.Level of evidenceIV (retrospective case series design).
Highlights
Total knee arthroplasty (TKA) is one of the most commonly performed elective procedures worldwide with excellent long-term outcomes [1, 2]
No significant differences between groups in terms of proportion of inliers for the hip–knee–ankle angle, femoral component angle, or tibial component angle were observed
Conclusions: operative time was significantly longer for trainee surgeons versus the supervisor, no significant differences in Range of motion (ROM), Knee Society Scores (KSS), or component positioning between supervisor and trainee surgeons were observed
Summary
Total knee arthroplasty (TKA) is one of the most commonly performed elective procedures worldwide with excellent long-term outcomes [1, 2]. Approximately 20% of primary TKA patients are not satisfied with their outcome [5]. Wilson et al [8] demonstrated that primary TKA was a relatively low-risk surgical procedure in terms of surgical, medical, and wound complications and surgical readmissions at their institution. The risk of wound complications was much higher in patients operated on by junior trainees than in those operated on by more experienced surgeons. A study of 673 TKAs showed no difference between consultant and trainee surgeons in terms of component alignment [11]
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