Fellowship training may be associated with improved outcomes after revision THA
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Key takeaways:
- Revision THA with a fellowship-trained surgeon was linked with improved outcomes vs. non-fellowship-trained surgeons.
- Fellowship training may improve perioperative management and increase exposure to techniques.
Published results showed patients who underwent revision total hip arthroplasty with a fellowship-trained surgeon had improved outcomes vs. patients who underwent surgery with a non-fellowship-trained surgeon.
Robert A. Burnett, MD, and colleagues from Rush University Medical Center performed a retrospective review of 5,880 patients who underwent aseptic revision THA and 1,622 patients who underwent head and liner exchange without explantation of implants for periprosthetic joint infection between 2010 and 2020 with 5-year follow-up.
Burnett and colleagues compared surgical outcomes between two matched cohorts of 580 patients who underwent surgery with a fellowship-trained surgeon and 580 patients who underwent surgery with a non-fellowship-trained surgeon.
Overall, patients who underwent aseptic revision THA with a fellowship-trained surgeon received fewer opioids in milligram morphine equivalents (132 vs. 165) and non-aspirin anticoagulants (21.4% vs. 32%) compared with patients who underwent surgery with a non-fellowship-trained surgeon.
Burnett and colleagues also found patients who underwent aseptic revision THA with a fellowship-trained surgeon had lower rates of dislocation (9.9% vs. 14.2%) and re-revision (15.2% vs. 21.3%) vs. patients who underwent surgery with a non-fellowship-trained surgeon. In addition, fellowship-trained surgeons had decreased odds of head and liner exchange failures vs. non-fellowship-trained surgeons (31.2% vs. 45.7%; OR = 0.76).
“Fellowship training appears to portend improved results for patients, likely through increased exposure to various techniques and improved perioperative management,” Burnett and colleagues wrote in the study.
Perspective
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This paper adds to the existing literature regarding the benefits of fellowship training. The authors referenced one of our studies demonstrating lower costs and better outcomes associated with total joints performed by fellowship-trained surgeons. We also noted lower costs and improved outcomes when fellowship-trained surgeons treat femoral neck fractures and total knee replacements. In addition, they identified that fellowship-trained surgeons are likely to perform a higher volume of revisions, leading to a lower complication rate, a concept that we have also demonstrated.
Based on their results, the authors conclude that one of the logical next steps in our approach to revision total joint replacements is to consider centers of excellence and revision total joint teams. However, this would require a significant change in our current payment structure to avoid focusing these high-cost procedures on a smaller group of specialized providers and institutions. Failure to do so may lead the hospitals and surgeons to be responsible for the increased burden of revisions, limiting access to care.
References:
Fang CJ, et al. J Arthroplasty. 2021;doi:10.1016/j.arth.2021.03.044.
Mahure SA, et al. J Arthroplasty. 2020;doi:10.1016/j.arth.2020.05.027.
Padilla JA, et al. J Arthroplasty. 2020;doi:10.1016/j.arth.2020.01.047.
Rizk AA, et al. J Arthroplasty. 2023;doi:10.1016/j.arth.2022.10.030.
Roof MA, et al. Bone Joint J. 2021;doi:10.1302/0301-620X.103B6.BJJ-2020-2287.R1.
Singh V, et al. Arthroplast Today. 2021;doi:10.1016/j.artd.2021.01.007.
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