# Association of resident training with complication risk in total hip and knee arthroplasty: a systematic review and meta-analysis

## TL;DR

This study finds that resident involvement in hip and knee surgeries does not increase most complications, except for a higher risk of deep infections.

## Contribution

The study provides a systematic review and meta-analysis on resident involvement in joint surgeries, identifying a specific risk of deep infection.

## Key findings

- Resident involvement was not linked to higher overall or surgical complications in hip and knee arthroplasty.
- Meta-analysis found a higher risk of deep infection with resident involvement (RR 1.55).

## Abstract

An important aspect of orthopedic residency is to gain experience and perform total joint arthroplasties to learn operating skills. For patients, a substantial concern is that resident involvement may result in more adverse events. We performed a systematic review with meta-analysis to evaluate whether resident involvement is associated with a higher complication rate in total hip and knee arthroplasty compared with procedures performed by orthopedic surgeons.

PubMed, Embase, Central, Cinahl, and Web of Science were systematically searched until November 2, 2023. Studies were assessed by 2 reviewers independently. All manuscripts were included describing: (i) complications in total hip and/or knee arthroplasty and (ii) comparing procedures with and without resident involvement.

29 studies could be included with a MINORS score ranging from 10 to 17. Resident involvement could not be associated with an increased overall and surgical complication rate in 9 (n = 51,442 patients) and 12 studies (n = 37,789 patients), respectively. The meta-analysis for deep infection showed an association with resident involvement (RR 1.55, 95% confidence interval 1.09–2.20, P = 0.01, 18 studies). In single studies, associations were seen for any urologic complication and sepsis. All other complications could not be related to resident involvement.

This systematic review could not find evidence that resident involvement was associated with more overall complications or surgical site complications except for deep infection. As previous studies showed an increased infection risk with prolonged duration of the procedure, consultants in teaching hospitals should be aware of this risk and be alert to teaching time to limit the risk for patients.