Fellowship Training in Adult Reconstruction Is Associated with Decreased Complications up to Two Years following Total Knee Arthroplasty.

Abstract

Fellowship training has become increasingly popular among orthopaedic residents, though its impact on arthroplasty outcomes has been underexplored. This study aimed to compare the incidences of complications, including periprosthetic joint infection (PJI), manipulation under anesthesia (MUA), aseptic revision, and aseptic loosening between patients who underwent primary TKA by an arthroplasty-trained surgeon versus a non-arthroplasty-trained surgeon at 90 days, one year, and two years postoperatively. A national insurance database was used to identify patients who underwent elective TKA from 2010 to 2021. A physician report was obtained for this cohort of patients, which included the name and National Provider Identifier (NPI) of the operative surgeon. Using this information, we performed a web search to identify whether each physician had undergone adult reconstruction fellowship training. Once surgeons were classified by training, we split the patients into two cohorts: those operated on by arthroplasty-trained surgeons and non-arthroplasty-trained surgeons. We employed a propensity-score match to account for demographic differences, resulting in two cohorts with 361,362 patients each. At 90 days, patients who were operated on by non-arthroplasty-trained surgeons experienced increased rates of surgical site infection (odds ratio (OR) 1.39, 95% confidence interval (CI) 1.26 to 1.54), venous thromboembolism (OR 1.14, 95% CI 1.02 to 1.26), periprosthetic joint infection (PJI) (OR 1.40, 95% CI 1.24 to 1.58), aseptic loosening (OR 1.62, 95% CI 1.15 to 2.29), and manipulation under anesthesia (MUA) (OR 1.23, 95% CI 1.16 to 1.30). At one and two years, higher incidences of PJI, aseptic loosening, and MUA persisted in the non-arthroplasty cohort. Additionally, the non-arthroplasty cohort demonstrated higher odds of aseptic revision at one year (OR 1.16, 95% CI 1.04 to 1.28) and two years (OR 1.28, 95% CI 1.18 to 1.39). Patients who underwent TKA with arthroplasty-trained surgeons experienced fewer complications at ninety days, one year, and two years postoperatively.