Correlation of Subspecialty Training With Clinical Outcomes After Total Hip Arthroplasty: Complications, Readmissions, and Implant Survival to Dislocation or Revision

Total hip arthroplasty (THA) is a commonly performed procedure with wonderful outcomes, but perioperative adverse events, dislocations, and need for revision can arise. This study explores how a surgeon's subspecialty training-arthroplasty, trauma, or nonarthroplasty/nontrauma-correlates with postoperative outcomes after THA.

Using the 2010 to 2022 M165Ortho PearlDiver Database, patients who underwent elective THA were identified. Patients were grouped based on the subspecialty training of the surgeon performing the procedure: arthroplasty, trauma, or nonarthroplasty/nontrauma. Multivariate analysis, adjusting for patient age, sex, and comorbidities, was used to compare 90-day adverse events and readmission rates between patient groups. Five-year dislocations and revisions were then assessed and compared with Kaplan-Meier analysis.

Of 742,630 THAs identified, nonarthroplasty, nontrauma surgeons conducted 677,094 (91.1%), arthroplasty surgeons conducted 61,826 (8.3%), and trauma surgeons conducted 3,711 (0.5%). Compared with nonarthroplasty nontrauma surgeons, arthroplasty-trained surgeons had lower odds of any adverse events (odds ratio [OR], 0.80; P < 0.001), serious adverse events (OR, 0.83; P < 0.001), and minor adverse events (OR, 0.80; P < 0.001). Specific adverse events with lower odds in the arthroplasty group included pulmonary embolism, sepsis, surgical site infection, acute kidney injury, pneumonia, and urinary tract infections. Compared with nonarthroplasty nontrauma surgeons, trauma-trained surgeons only had higher odds of wound dehiscence (OR, 1.42; P = 0.001). The 5-year revision rates were lowest in the arthroplasty group (3.1%), followed by the nontrauma, nonarthroplasty group (3.5%; P < 0.001) and the trauma group (4.5%; P < 0.001). Similar patterns were observed in the 5-year hip dislocation rates.

Subspecialty training in arthroplasty is associated with lower complication rates and better implant survival after THA. These findings suggest that arthroplasty training is associated with improved outcomes, potentially contributed to experience, volume, and/or care pathways.