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. 2022 Apr 8:15:202-209.e4.
doi: 10.1016/j.artd.2022.02.029. eCollection 2022 Jun.

Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty

Aditya V Maheshwari  1 , Christopher T Garnett  1 , Tzu H Cheng  1   2 , Joshua R Buksbaum  1 , Vivek Singh  1   3 , Neil V Shah  1
Affiliations

Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty

Aditya V Maheshwari et al. Arthroplast Today. .

Abstract

Background: Although several studies have indirectly compared teaching and nonteaching hospitals, results are conflicting, and evaluation of the direct impact of trainee involvement is lacking. We investigated the direct impact of resident participation in primary total knee arthroplasties (TKAs).

Material and methods: Fifty patients undergoing single-staged sequential bilateral primary TKAs were evaluated. The more symptomatic side was performed by the attending surgeon first, followed by the contralateral side performed by a chief resident under direct supervision and assistance of the same attending surgeon. Surgery was subdivided into 8 critical steps on both sides. The overall time and critical stepwise surgical time and short-term clinical outcomes were then compared between the 2 sides.

Results: The attending surgeon completed the surgery (skin incision to dressing) significantly faster than the resident (70.2 vs 96.9 minutes) by a mean of 26.7 minutes (P < .05) and was also faster in all steps. The most significant differences in time were in "exposure" (9.5 vs 16.5 minutes) and "closure" steps (13.2 vs 24.9 minites), all P < .001. Adverse events occurred in 7 patients; 5 of these resolved uneventfully. There were no significant differences in surgical complications, objective outcome scores, or patient satisfaction scores between both sides.

Conclusion: Resident participation in TKA increased operative time without jeopardizing short-term patient clinical outcomes, satisfaction, and complications. This may alleviate concerns from patients and policymakers about TKA in an academic setting. Surgical "exposure" and "closure" were the most prolonged steps for the residents, and they may benefit with more focus and/or simulation studies during training.

Keywords: Orthopaedic surgery; Postoperative outcomes; Residency training; Resident education; Single-staged bilateral; Total knee arthroplasty.

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References

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Further Reading

    1. Maheshwari A.V., Blum Y.C., Shekhar L., Ranawat A.S., Ranawat C.S. Multimodal pain management after total hip and knee arthroplasty at the ranawat orthopaedic center. Clin Orthop Relat Res. 2009;467:1418. - PMC - PubMed
    1. Ranawat A.S., Ranawat C.S., Elkus M., Rasquinha V.J., Rossi R., Babhulkar S. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg Am. 2005;87:271. - PubMed
    1. Sharma V., Tsailas P.G., Maheshwari A.V., Ranawat A.S., Ranawat C.S. Does patellar eversion in total knee arthroplasty cause patella baja? Clin Orthop Relat Res. 2008;466:2763. - PMC - PubMed
    1. Scott R.D. Ligament releases. Orthopedics. 1994;17:883. - PubMed
    1. Koenig J.H., Maheshwari A.V., Ranawat A.S., Ranawat C.S. Extra-articular deformity is always correctable intra-articularly: in the affirmative. Orthopedics. 2009;32:676. - PubMed

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