Survey: Residents may benefit from more training in cemented femoral hip stem placement
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CHICAGO — Based on results of a recent survey of senior residents, a presenter said cementing femoral stems during total hip arthroplasty is an area of orthopedic training and skill that likely can be improved.
During a Hip Society session held on specialty day at the American Academy of Orthopaedic Surgeons Annual Meeting, James A. Browne, MD, FAAOS, discussed results of 152 surveys that senior orthopedic residents completed about a year ago when they attended a national board review course.
The focus of the session in which the results were presented was avoiding femur fractures in primary THA.
The survey findings revealed a gap in the training of U.S. orthopedic surgery residents that Browne said may leave residents with inadequate or insufficient competency when it comes to cementing THA stems.
Importance of good cement technique
Being aware of residents’ possible skill and training deficiencies in this area is important because a good cementation technique is integral to outcomes of THA, Browne said.
“The vast majority of our residents will end up cementing femoral components in their practice. This is going to be predominantly in the hemiarthroplasty, femoral neck fracture cohort, which I think is an important cohort to think about in terms of revision surgery. And, unfortunately, many of these residents do not feel well trained or prepared in this skill as they enter practice,” Browne said.
Among residents who anticipated treating patients with femoral neck fractures in their practice (92%), 100% said they anticipated using cement in some of those cases. “That may be encouraging, but it may be concerning as well,” Browne said.
Elective THA, hemiarthroplasty results
When asked the percentage of elective THA surgeries that used cemented femoral components during their residency training, “33% said zero,” he said. “So, one in three of our trainees have never seen a cemented femoral component.”
Of those surveyed, 16% had seen five or fewer cemented hemiarthroplasties during training, Browne said.
Following residency, 21% of those surveyed planned to complete a fellowship in adult reconstruction, according to Browne. “Presumably, those surgeons would gain more experience after the point at which we surveyed them.”
When it came to residents’ perception of the theoretical training they received about cemented femoral components, 16% to 17% said it was inadequate. “About half of them thought it was acceptable,” Browne said.
He continued, “We asked them about their general satisfaction with training on cement technique; 13% said they were either dissatisfied or very dissatisfied with their training; 60% said they were satisfied or very satisfied.”
“So, by average, our trainees are coming out feeling more prepared and comfortable using cementless stems compared to cemented components,” Browne said.
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Browne JA. There has been a gap in our U.S. training: The path forward. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 22-26, 2022; Chicago.
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