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What Are the Relative Associations of Surgeon Performance and Prosthesis Quality With THA Revision Rates?

Wayne Hoskins^1,2, Roger Bingham³, Stephen E Graves⁴

¹Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia.

Clinical Orthopaedics and Related Research

|August 8, 2024

Summary

Surgeon skill significantly impacts total hip arthroplasty (THA) revision rates, independent of implant choice. High-revision surgeons face more preventable complications, necessitating further analysis into surgeon-specific factors beyond prosthesis selection.

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The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

Published on: August 4, 2022

Area of Science:

Orthopedic surgery
Arthroplasty outcomes
Surgical quality assessment

Background:

Total hip arthroplasty (THA) revision risk is multifactorial, including patient, implant, and surgeon variables.
Surgeon expertise's role as a confounding variable in revision outcomes is under-analyzed in national registries.
Investigating surgeon-specific revision rates is crucial for understanding and improving arthroplasty success.

Purpose of the Study:

To determine if surgeon revision rate differences persist when accounting for prosthesis performance.
To assess if the benefit of superior prostheses varies among surgeons with different revision rates.
To compare reasons for revision between high- and low-revision rate surgeons.

Main Methods:

Analysis of 302,066 primary THA procedures for osteoarthritis from the AOANJRR (1999-2022).
Surgeons categorized by performance, and prostheses classified as superior, middle, or higher-revision rate.
Comparison of all-cause revision rates across surgeons, controlling for prosthesis selection and analyzing revision causes.

Main Results:

Surgeon-specific revision rate differences persisted even after adjusting for prosthesis choice.
Superior prostheses lowered revision rates for all surgeons, with a more pronounced effect for high-revision surgeons.
High-revision surgeons showed increased rates of likely preventable revisions unrelated to implant selection.

Conclusions:

Both implant choice and surgeon factors significantly influence THA revision risk and reasons.
Surgeons can improve arthroplasty survivorship by selecting lower-revision-rate implants.
Further investigation into surgeon-specific factors (training, patient selection) is essential to reduce preventable revisions.