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Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis

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:...

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Autores principales: Fowler, Timothy J, Aquilina, Alex L, Blom, Ashley W, Sayers, Adrian, Whitehouse, Michael R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8587578/
https://www.ncbi.nlm.nih.gov/pubmed/34758989
http://dx.doi.org/10.1136/bmjopen-2020-047882
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author Fowler, Timothy J
Aquilina, Alex L
Blom, Ashley W
Sayers, Adrian
Whitehouse, Michael R
author_facet Fowler, Timothy J
Aquilina, Alex L
Blom, Ashley W
Sayers, Adrian
Whitehouse, Michael R
author_sort Fowler, Timothy J
collection PubMed
description 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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spelling pubmed-85875782021-11-15 Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis Fowler, Timothy J Aquilina, Alex L Blom, Ashley W Sayers, Adrian Whitehouse, Michael R BMJ Open Surgery 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. BMJ Publishing Group 2021-11-10 /pmc/articles/PMC8587578/ /pubmed/34758989 http://dx.doi.org/10.1136/bmjopen-2020-047882 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Surgery
Fowler, Timothy J
Aquilina, Alex L
Blom, Ashley W
Sayers, Adrian
Whitehouse, Michael R
Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis
title Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis
title_full Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis
title_fullStr Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis
title_full_unstemmed Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis
title_short Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis
title_sort association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8587578/
https://www.ncbi.nlm.nih.gov/pubmed/34758989
http://dx.doi.org/10.1136/bmjopen-2020-047882
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