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

ObjectiveTo investigate the association between surgeon grade (trainee vs consultant) and implant survival following primary hip and knee replacement.DesignA systematic review and meta-analysis of observational studies.Data sourcesMEDLINE and Embase from inception to 6 October 2021.SettingUnits performing primary hip and/or knee replacements since 1990.ParticipantsAdult patients undergoing either a primary hip or knee replacement, predominantly for osteoarthritis.InterventionWhether the surgeon recorded as performing the procedure was a trainee or not.Primary and secondary outcome measuresThe 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.ResultsNine 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.ConclusionsThere 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 numberCRD42019150494.

Inaugural MSK Medicine Module: An innovative multidisciplinary medical education model

Background Given the increased need to enhance musculoskeletal education, an inaugural musculoskeletal (MSK) focused module was developed and evaluated as part of an orthopedic surgery training program at the University of Toronto. The educational offerings were based on a previously validated MSK Curriculum. Specifically, the aims are to evaluate the effectiveness of the module on 1) improving MSK knowledge and skills expected of graduating Orthopaedic residents and 2) the ability of residents to collaborate professionally with non-surgical MSK clinicians. Methods Nine residents initially selected to participate in the competency based curriculum for orthopaedic surgery completed this module as an essential component of their training. The module was experienced during the mid-point of training (PGY 3 equivalent). An evaluation template was developed using pre and post module multiple choice (MCQ) and short answer questions (SAQ) to assess knowledge; summary of in-training education reports (ITERs) of clinical educational experiences and; feedback obtained for scholarly presentations. Structured feedback was obtained from learners and educators to evaluate the effectiveness of the module and to inform changes to optimize future learning opportunities and environments. Results Nine residents completed the pilot study. The module was 8 weeks long. Learners rotated through clinical settings within five educational pillars. All residents demonstrated improvements in MSK medicine knowledge expected of graduating Orthopaedic residents with a 40% increase in mean MCQ scores (76% vs 60%; p<0.001) and 58% improvement in mean SAQ scores (78% vs 47%; p<0.001). Professionalism evaluations revealed performance above the expected level with a mean in-training education reports score of 4.19 out of 5 (SD: 0.44; range, 3.73 to 5). Conclusion Completing a MSK medicine module at the mid-point of postgraduate Orthopaedic training positively impacts acquisition of relevant MSK knowledge and skill, while facilitating interdisciplinary management of patients with MSK conditions using a new educational paradigm.

793 Orthopaedic Surgical Training in The Independent Sector During the COVID 19 Pandemic

Introduction The COVID pandemic had led to the cancellation of elective Orthopaedics in the NHS. The aim of this study was to investigate the effect of the independent sector on orthopaedic training and the effect of the COVID pandemic on training locally. Method A retrospective review of trauma and elective operations was made between April and September of 2019 and 2020 to compare the effects of COVID on training opportunities and the additional capacity provided by the private sector. Results The impact of COVID on Surgical training at GWH has been no decrease in trauma operating experience, but a 53% decrease in elective operating experience and a 74% decrease in joint replacement operative experience during an equivalent six-month period. Use of the independent hospital has enabled 6% of the total elective surgery experience, and 11% of the joint replacement surgery experience. Discussion The private sector has provided additional capacity but a productivity of 66 cases from 48 half day lists is low (1.4 cases per list) has proved disappointing. There has been a low impact on elective training. The challenges have been faced on the elective side as trauma cases have remained consistent during the pandemic. Conclusions Use of the alliance between the private sector and NHS as a resource to provide additional training opportunities needs to be developed further in the future with incentivised guidance. Orthopaedic training will inevitably adapt to the challenges presented for the next generations of surgeons.