Early career surgeons may experience learning curve for complex revision arthroplasty
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Key takeaways:
- The senior experienced surgeon had faster procedures for revision total hip and knee arthroplasties.
- Senior experience was linked to decreased blood loss for revision total knee arthroplasty.
SAN FRANCISCO — Results presented here showed early career surgeons experienced a learning curve for complex revision arthroplasty that may be due to surgeon and patient factors and revision indication.
“Focus early on should be placed on efficiency in the operating room. You can decrease operative time and blood loss, and this could be done with senior partner assistance with preoperative planning or being available for the case to help out,” Kent R. Kraus, MD, a resident physician in the department of orthopedic surgery at the Indiana University School of Medicine, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Kraus and colleagues reviewed aseptic revision total joint arthroplasties performed during a 2-year period by two surgeons who were 0 to 2 years out of fellowship (inexperienced group), one surgeon who was 4 to 6 years out of fellowship (early experience group) or one surgeon who was 15 to 17 years out of fellowship (senior experienced group).
“The outcomes we looked at were procedure duration; intraoperative complications, like bone marrow or soft tissue injuries; estimated blood loss; blood transfusion during hospital stay; and reoperations within 1 year,” Kraus said.
While surgeon groups had similar patients who underwent revision total hip arthroplasty, Kraus said the senior experienced surgeon had more female patients, older patients with decreased BMI and patients with less bony deformity requiring augmentation or bone grafting who underwent revision total knee arthroplasty.
“When we looked at procedure duration, we found that the senior experienced surgeon had significantly lower procedure durations for both revision hips and revision knees at 92 [minutes] and 95 minutes, respectively,” Kraus said. “This was at least 70 minutes shorter than the inexperienced group.”
Multivariate analysis showed experience remained a significant predictor for procedure duration in revision THA. However, Kraus said procedure duration increased with patients who had higher BMI and decreased with older patient age in revision TKA.
Senior experience yielded decreased blood loss for revision TKA, but there was no significant difference among surgeon groups regarding blood loss for revision THA, according to Kraus. Although surgeon experience did not remain a significant predictor for blood loss in multivariate analysis, older patient age favored less blood loss and longer procedure duration led to more blood loss.
“We found no difference between the groups in intraoperative fractures, nerves or soft tissue injuries; the rate of blood transfusions or reoperations within 1-year revision,” Kraus said.
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Kraus KR, et al. Paper 466. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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