Lower Complication and Revision Rates Among Patients Who Undergo Unicompartmental Knee Arthroplasty Performed by Adult Reconstruction-Trained Surgeons.

Abstract

The purpose of this study was to compare outcomes for patients undergoing unicompartmental knee arthroplasty (UKA) by adult reconstruction fellowship-trained surgeons and non-fellowship-trained surgeons. A large administrative claims database was queried for patients undergoing primary, elective UKA between 2010 and 2019 with a minimum of 5-year follow-up. Patients who underwent UKA by surgeons who were fellowship trained in adult reconstruction were matched 1:1 based on age, Elixhauser Comorbidity Index, obesity, osteoporosis, tobacco use, alcohol use, and insurance plan to patients who underwent UKA by non-adult reconstruction fellowship-trained surgeons. The incidence of 90-day medical and surgical complications, as well as 2- and 5-year complication and reoperation rates, was identified via International Classification of Diseases coding and compared between matched groups. The final cohort included 25,278 matched pairs of patients who underwent UKA either by fellowship-trained or non-fellowship-trained surgeons. There were no statistically significant differences in 90-day medical and surgical complication rates between cohorts (all P > 0.05). At both 2- and 5-year follow-ups, patients who underwent UKA by adult reconstruction fellowship-trained surgeons were less likely to experience periprosthetic fracture (two years: odds ratio [OR]: 0.58, P = 0.018; five years: OR: 0.62, P = 0.013), aseptic loosening (two years: OR: 0.78, P = 0.031; five years: OR: 0.71, P < 0.001), implant failure (two years: OR: 0.39, P < 0.001; five years: OR: 0.52, P < 0.001), mechanical complication (two years: OR: 0.77, P = 0.010; five years: OR: 0.81, P = 0.009), or require revision to total knee arthroplasty (two years: OR: 0.69, P < 0.001; five years: OR: 0.69, P < 0.001). These data suggest that surgeons who had fellowship training in adult reconstruction demonstrated lower rates of complications and revision to total knee arthroplasty when performing UKA. The non-adult reconstruction fellowship-trained surgeons wishing to incorporate UKA into their practice may consider pursuing additional training to optimize outcomes for their patients.