Abstract
Over 2.5 million primary hip and knee replacements have been performed in England and Wales since the inception of the National Joint Registry (NJR) in 2003. These common procedures provide a cost effective means of treating end-stage osteoarthritis. However, implant constructs are susceptible to failure, which often requires revision surgery. The revision-free survival of a joint replacement is a commonly used measure of surgical performance.Hip and knee replacements are performed by surgeons of different grades with varying levels of supervision. It is not known if total hip replacements (THRs), total knee replacements (TKRs), or unicompartmental knee replacements (UKRs) performed by trainees last as long as those performed by consultants. The primary aim of this thesis was to investigate the association between surgeon grade (trainee or consultant) and implant survival following THR, TKR, and UKR.
A preliminary study using methods of evidence synthesis, found no strong evidence in the existing literature that trainees achieve worse outcomes compared to consultants, in terms of the net survival or crude revision rate of hip and knee replacements with 5 to 10 years follow-up. Three studies using NJR data were conducted to investigate the association between surgeon grade, the supervision of trainees, and the risk of all-cause revision following THR, TKR, and UKR. The indication for revision was explored as a secondary outcome measure. A combination of statistical methods including Kaplan-Meier, Cox regression, and flexible parametric survival analysis were employed. A final study using a local database explored the association between surgeon grade and a range of clinical, functional, and radiological outcome measures.
In general, the findings of this thesis support the conclusion that trainees in England and Wales achieve comparable all-cause implant survival to consultants following THR, TKR, and UKR. However, trainees should ideally be supervised by a scrubbed consultant when performing these procedures.
| Date of Award | 27 Sept 2022 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Michael R Whitehouse (Supervisor) & Adrian E Sayers (Supervisor) |