Surgical Training and Dislocation after Total Hip Arthroplasty: Examining a Proficiency-Related Complication

Roughly 500,000 total hip arthroplasties (THAs) are performed each year in the US, often with participation of resident surgeons. Though previous studies have not established a link between resident involvement in orthopedic surgery and complications, these investigations have lacked data such as number of residents involved, year-in-training, involvement of physician extenders, and level of attending involvement.

A retrospective study examined all patients who underwent THAs at the Veterans Affairs (VA) Puget Sound from 1999-2016 and had a minimum of 90 days of follow-up. Data was collected on patient and treatment factors as well as postoperative dislocation. Logistic regression analysis was employed to determine the characteristics associated with dislocation.

Twenty-three patients (2.5%) experienced a dislocation. Dislocation was associated with increasing age (p = 0.004) and THA head diameter (p < 0.001), but not with year-in-training of the most senior resident (p=1.00) or number of residents involved (p=1.00), and did not vary significantly by form of attending involvement (p = 0.837). Multivariable analysis demonstrated independent associations of patient age (OR 1.056 per additional year, p = 0.009) and THA head diameter (OR 0.806 per additional millimeter, p = 0.002) with dislocation.

Dislocation was associated with increasing patient age and smaller THA head diameter, but not factors related to surgical training. THA may be safely performed by residents supervised through graduated autonomy, with the degree of attending supervision varying by case complexity and the resident's experience and skill. Level of Evidence: III.