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. 2025 Jun 9;17(6):e85637.
doi: 10.7759/cureus.85637. eCollection 2025 Jun.

Impact of Fellowship Training Type on Complication Rates in Primary and Revision Total Knee Arthroplasty by Recently Trained Board-Eligible Orthopedic Surgeons

Allyson N Pfeil  1 , Joshua H Taylor  1 , Purvi Desai  2 , Corey F Hryc  1 , Warren R Dunn  1 , Anay R Patel  1
Affiliations

Impact of Fellowship Training Type on Complication Rates in Primary and Revision Total Knee Arthroplasty by Recently Trained Board-Eligible Orthopedic Surgeons

Allyson N Pfeil et al. Cureus. .

Abstract

Background: Demand for primary total knee arthroplasty (TKA) and revision TKA (rTKA) procedures is projected to increase. Many orthopedic surgery residents pursue fellowship training following residency. In investigating the impact of fellowship subspecialization on surgical outcomes, we hypothesize that procedures performed by arthroplasty-trained orthopedic surgeons will have the most favorable complication, readmission, and reoperation rates compared to other fellowships or those without fellowship training.

Materials and methods: The American Board of Orthopaedic Surgeons (ABOS) database was queried for all adult cases of TKA and rTKA submitted between 2003 and 2019, identifying 64,437 cases performed by 4,758 candidates. Fellowship groupings included adult reconstruction (AR), sports medicine (SM), other (OTH), and no fellowship (NO). Adverse events, including complications, readmissions, and reoperations, were collected for each case. Multivariate logistic regression analyses were used in congruence with the Wald test. Chi-square tests assessed descriptive data. Statistically significant P-values were defined at P < 0.05.

Results: NO reported the least surgical and medical complications at 10.25% (n=1176) and 7.25% (n=832), respectively (P=0.001). Of AR cases, 11.6% (n=4652) experienced surgical complications. AR achieved the lowest reoperation rate of 4.45% (n=965) (P=0.002). Cases managed by SM incurred a 20% decreased readmission risk (P=0.032) compared to AR.

Conclusions: AR candidates reported the lowest rates of reoperation and comparatively low rates of surgical complications. However, NO generalists reported the lowest rate of surgical and medical complications, which may be influenced by patient selection.

Keywords: abos; american board of orthopaedic surgery; complications; early-career surgeons; fellowship; orthopaedic subspecialization; revision tka; specialty; surgical complications; total knee arthroplasty.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Texas Orthopedic Hospital Institutional Review Committee issued approval TOH223e. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Fellowship utilization trends by candidate.
AR: adult reconstruction; SM: sports medicine; OTH: other
Figure 2
Figure 2. Trends in included cases and candidates attempting ABOS part II exam.
ABOS: American Board of Orthopaedic Surgeons
Figure 3
Figure 3. Trends in included average cases per candidate by fellowship type attempting ABOS part II exam.
AR: adult reconstruction; SM: sports medicine; ABOS: American Board of Orthopaedic Surgeons
See this image and copyright information in PMC

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