Impact of Fellowship Training Type on Complication Rates in Primary and Revision Total Knee Arthroplasty by Recently Trained Board-Eligible Orthopedic Surgeons

TL;DR

This study examines how different types of fellowship training affect complication rates in knee replacement surgeries performed by orthopedic surgeons.

Contribution

The study provides new evidence on how fellowship specialization influences surgical outcomes in TKA and rTKA.

Findings

Surgeons without fellowship training had the lowest surgical and medical complication rates.

Arthroplasty-trained surgeons had the lowest reoperation rates.

Sports medicine-trained surgeons had a 20% lower readmission risk compared to arthroplasty-trained surgeons.

Abstract

Background: Demand for primary total knee arthroplasty (TKA) and revision TKA (rTKA) procedures is projected to increase. Many orthopedic surgery residents pursue fellowship training following residency. In investigating the impact of fellowship subspecialization on surgical outcomes, we hypothesize that procedures performed by arthroplasty-trained orthopedic surgeons will have the most favorable complication, readmission, and reoperation rates compared to other fellowships or those without fellowship training.

Materials and methods: The American Board of Orthopaedic Surgeons (ABOS) database was queried for all adult cases of TKA and rTKA submitted between 2003 and 2019, identifying 64,437 cases performed by 4,758 candidates. Fellowship groupings included adult reconstruction (AR), sports medicine (SM), other (OTH), and no fellowship (NO). Adverse events, including complications, readmissions, and reoperations, were collected for each case. Multivariate logistic regression analyses were used in congruence with the Wald test. Chi-square tests assessed descriptive data. Statistically significant P-values were defined at P < 0.05.

Results: NO reported the least surgical and medical complications at 10.25% (n=1176) and 7.25% (n=832), respectively (P=0.001). Of AR cases, 11.6% (n=4652) experienced surgical complications. AR achieved the lowest reoperation rate of 4.45% (n=965) (P=0.002). Cases managed by SM incurred a 20% decreased readmission risk (P=0.032) compared to AR.

Conclusions: AR candidates reported the lowest rates of reoperation and comparatively low rates of surgical complications. However, NO generalists reported the lowest rate of surgical and medical complications, which may be influenced by patient selection.

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