The risk of early revision after trainee led primary unicompartmental and total knee replacement

Abstract

Background: Orthopaedic trainees must demonstrate competence in performing major joint replacement. This study aimed to determine the impact of lead surgeon grade and level of supervision for trainee led operations on the incidence of early revision procedures following elective primary knee replacement.

Methods: Data from the National Joint Registry was obtained for all primary elective total (TKR) and partial (UKR) knee replacements performed within a single NHS University Teaching Hospital from 2007 to 2021. Multivariate logistic regression was used to determine the risk of all cause revision within 1-year of the index procedure in relation to surgeon grade and level of supervision for trainee led (TL) operations.

Results: 9,931 primary knee replacements (KR) were undertaken, of which 4850 (48.8 %) were UKR. Revision procedures were performed in 109 (1.1 %) patients within 1-year of their index operation. The risk of revision was not significantly different for consultant-led (CL) or TL operations (OR 0.84, CI 0.55-1.26, p = 0.4). In comparison to CL operations, no difference was observed in the risk of revision for either consultant-supervised trainee (TS, OR 0.83, CI 0.49-1.35, p = 0.7) or non-consultant supervised trainee (TU, OR 0.84, CI 0.46-1.43, p = 0.7) operations. These trends remained on sub-analysis for both UKR and TKR operations.

Conclusions: No differences were observed in the incidence of revision within 1-year of primary KR between consultant led and trainee led operations. These findings suggest that training surgeons in both TKR and UKR operations is not associated with an increased risk of early adverse patient outcomes requiring revision surgery.

Keywords: Arthroplasty; Knee; Replacement; Revision; TKR; Training; UKR.