Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained Surgeons
Background: An adult reconstruction (AR) fellowship is designed to provide advanced training for a broad range of primary reconstructive and complex knee revision surgeries. This study aims to identify outcome differences between primary total knee arthroplasty (TKA) performed by AR fellowship-train...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-04-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344121000078 |
| _version_ | 1818650671854911488 |
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| author | Vivek Singh, MD Trevor Simcox, MD Vinay K. Aggarwal, MD Ran Schwarzkopf, MD, MSc William J. Long, MD, FRCSC |
| author_facet | Vivek Singh, MD Trevor Simcox, MD Vinay K. Aggarwal, MD Ran Schwarzkopf, MD, MSc William J. Long, MD, FRCSC |
| author_sort | Vivek Singh, MD |
| collection | DOAJ |
| description | Background: An adult reconstruction (AR) fellowship is designed to provide advanced training for a broad range of primary reconstructive and complex knee revision surgeries. This study aims to identify outcome differences between primary total knee arthroplasty (TKA) performed by AR fellowship-trained surgeons and non-AR (NAR) fellowship-trained surgeons. Material and Methods: We retrospectively reviewed 7415 patients who underwent primary TKA from 2016 to 2020. Two cohorts were established based on whether the operation was performed by an AR or NAR fellowship-trained surgeon. Demographic, clinical data, and patient-reported outcome measures were collected at various time-points (preoperatively, 3 months, 1 year). Demographic differences were assessed with chi-square and independent sample t-tests. Primary outcomes were compared using multilinear regressions, controlling for demographic differences. Results: AR surgeons performed 5194 (70%) cases while NAR surgeons performed 2221 (30%) cases. Surgical time (minutes) significantly differed between the 2 groups (101.26 vs 111.56; P < .001). Length of stay, 90-day all-cause readmissions, revisions, and all-cause emergency department visits did not statistically differ (P = .079, P = .978, P = .094, and P = .241, respectively). AR surgeons were more likely to discharge their patients home than NAR surgeons (P = .001). NAR group reported lower KOOS, JR scores at 3 months and 1 year (preop: 45.30 vs 45.79, P = .728; 3 months: 64.73 vs 59.47, P < .001; 1 year: 71.66 vs 69.56, P = .234); however, only 3-month scores statistically differed. Veterans RAND-12 Physical and Mental components scores (VR-12 PCS and MCS) were not statistically significant at any time-point between the cohorts. Delta-improvements preoperatively to 1 year in KOOS, JR (26.36 vs 23.77; P < .001) and VR-12 PCS (11.98 vs 10.62; P < .001) scores were significantly higher for the AR cohort but did not exceed the minimal clinically important difference. Conclusion: This study demonstrates significantly shorter surgical times and greater improvements in KOOS, JR and VR-12 PCS scores associated with TKAs performed by AR fellowship-trained surgeons. Level III Evidence: Retrospective Cohort Study |
| first_indexed | 2024-12-17T01:53:56Z |
| format | Article |
| id | doaj.art-b86b577afbab47b69e30ae0e973ef8d6 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-12-17T01:53:56Z |
| publishDate | 2021-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-b86b577afbab47b69e30ae0e973ef8d62022-12-21T22:07:59ZengElsevierArthroplasty Today2352-34412021-04-0184045Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained SurgeonsVivek Singh, MD0Trevor Simcox, MD1Vinay K. Aggarwal, MD2Ran Schwarzkopf, MD, MSc3William J. Long, MD, FRCSC4NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USANYU Winthrop Hospital, Department of Orthopedic Surgery, Mineola, NY, USANYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USANYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USANYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA; Corresponding author. 301 East 17th Street, New York, NY 10003, USA. Tel.: +1 646 293 7515.Background: An adult reconstruction (AR) fellowship is designed to provide advanced training for a broad range of primary reconstructive and complex knee revision surgeries. This study aims to identify outcome differences between primary total knee arthroplasty (TKA) performed by AR fellowship-trained surgeons and non-AR (NAR) fellowship-trained surgeons. Material and Methods: We retrospectively reviewed 7415 patients who underwent primary TKA from 2016 to 2020. Two cohorts were established based on whether the operation was performed by an AR or NAR fellowship-trained surgeon. Demographic, clinical data, and patient-reported outcome measures were collected at various time-points (preoperatively, 3 months, 1 year). Demographic differences were assessed with chi-square and independent sample t-tests. Primary outcomes were compared using multilinear regressions, controlling for demographic differences. Results: AR surgeons performed 5194 (70%) cases while NAR surgeons performed 2221 (30%) cases. Surgical time (minutes) significantly differed between the 2 groups (101.26 vs 111.56; P < .001). Length of stay, 90-day all-cause readmissions, revisions, and all-cause emergency department visits did not statistically differ (P = .079, P = .978, P = .094, and P = .241, respectively). AR surgeons were more likely to discharge their patients home than NAR surgeons (P = .001). NAR group reported lower KOOS, JR scores at 3 months and 1 year (preop: 45.30 vs 45.79, P = .728; 3 months: 64.73 vs 59.47, P < .001; 1 year: 71.66 vs 69.56, P = .234); however, only 3-month scores statistically differed. Veterans RAND-12 Physical and Mental components scores (VR-12 PCS and MCS) were not statistically significant at any time-point between the cohorts. Delta-improvements preoperatively to 1 year in KOOS, JR (26.36 vs 23.77; P < .001) and VR-12 PCS (11.98 vs 10.62; P < .001) scores were significantly higher for the AR cohort but did not exceed the minimal clinically important difference. Conclusion: This study demonstrates significantly shorter surgical times and greater improvements in KOOS, JR and VR-12 PCS scores associated with TKAs performed by AR fellowship-trained surgeons. Level III Evidence: Retrospective Cohort Studyhttp://www.sciencedirect.com/science/article/pii/S2352344121000078Adult reconstruction fellowshipArthroplasty fellowshipTotal knee arthroplastyPatient reported outcome measuresClinical outcomes |
| spellingShingle | Vivek Singh, MD Trevor Simcox, MD Vinay K. Aggarwal, MD Ran Schwarzkopf, MD, MSc William J. Long, MD, FRCSC Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained Surgeons Arthroplasty Today Adult reconstruction fellowship Arthroplasty fellowship Total knee arthroplasty Patient reported outcome measures Clinical outcomes |
| title | Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained Surgeons |
| title_full | Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained Surgeons |
| title_fullStr | Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained Surgeons |
| title_full_unstemmed | Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained Surgeons |
| title_short | Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained Surgeons |
| title_sort | comparative analysis of total knee arthroplasty outcomes between arthroplasty and nonarthroplasty fellowship trained surgeons |
| topic | Adult reconstruction fellowship Arthroplasty fellowship Total knee arthroplasty Patient reported outcome measures Clinical outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S2352344121000078 |
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