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Surgeon Training and Revision Rates After Patellofemoral Arthroplasty.
Louise Eggers Rasmussen1,2,3, Adam Gorm Hoffmann4, Paul Blanche4
1Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
JAMA Network Open
|June 27, 2025
Summary
Focused patellofemoral arthroplasty (PFA) training for surgeons significantly reduces revision rates. This study highlights surgeon training as a crucial factor in PFA outcomes, potentially explaining discrepancies in registry data.
Area of Science:
- Orthopedic Surgery
- Biostatistics
- Health Services Research
Background:
- Registry-based studies often overlook surgeon training, leading to confounding bias in implant outcome assessments.
- Discrepancies between clinical trial and registry data for patellofemoral arthroplasty (PFA) outcomes may stem from variations in surgeon expertise.
- Evaluating the impact of specialized surgeon training is crucial for accurate assessment of PFA implant performance.
Purpose of the Study:
- To compare the revision rates of patellofemoral arthroplasty (PFA) performed by surgeons with specialized PFA training versus those without.
- To investigate the influence of focused surgical training on PFA outcomes, including revision, reoperation, and mortality rates.
- To assess whether surgeon training level acts as a confounder in registry-based PFA outcome studies.
Main Methods:
- A population-based cohort study emulating a target trial design.
- Comparison of PFA outcomes between patients operated on by PFA-trained (trial) surgeons and those operated on by general knee surgeons (nontrial surgeons).
- Utilized Danish registries and hospital records for 482 primary PFA procedures (2008-2015) with 6-year follow-up, employing logistic regression for adjusted risk ratio calculations.
Main Results:
- Patients operated on by PFA-trained surgeons had a significantly lower 6-year revision rate (8% vs. 26%, adjusted RR 0.35, P < .001).
- No significant difference was observed in reoperation rates (adjusted RR 0.71, P = .19) or mortality (adjusted RR 1.11, P = .79) between the groups.
- Surgeons with PFA training operated on patients with more severe osteoarthritis grades compared to nontrial surgeons.
Conclusions:
- Specialized PFA surgeon training is associated with a substantially lower cumulative 6-year revision rate.
- Surgeon training level is a significant confounder in registry-based PFA outcome comparisons.
- Incorporating surgeon training data is essential for accurate interpretation of implant performance in registries.
