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The Impact of Arthroplasty Training on Outcomes Following Hemiarthroplasty: A Propensity Score-Matched Analysis
Gabrielle Swartz1, Reza Katanbaf1, Monica Misch1
1The Rubin Institute for Advanced Orthopedics, Lifebridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland.
Background:
Hip hemiarthroplasty is the most frequently performed treatment for femoral neck fractures, which are projected to rise in incidence over the next century with an aging population. This study sought to compare the incidences of complications, including periprosthetic joint infections, periprosthetic fractures, and dislocations, between patients who underwent hip hemiarthroplasty by an arthroplasty-trained surgeon versus a nonarthroplasty surgeon at 90 days, one year, and two years.
Methods:
We queried a national, all-payer database to identify patients who underwent hip hemiarthroplasty for femoral neck fracture. Physician reports were produced on these patients, which included surgeon information such as National Provider Identifier, name, and location. A web search was performed to determine the fellowship training of each surgeon. Patients were then separated into two equal cohorts based on the surgeon who performed their hemiarthroplasty: arthroplasty-trained (n = 10,806) and nonarthroplasty-trained (n = 10,806). A propensity score match was utilized to control for patient factors and comorbidities.
Results:
Patients who were treated by nonarthroplasty-trained surgeons experienced higher rates of surgical site infection at 90 days (P < 0.001) and periprosthetic fracture at 90 days (P = 0.015), one year (P = 0.004), and two years (P = 0.036). Additionally, patients treated by nonarthroplasty-trained surgeons experienced higher rates of aseptic revision at one year (P = 0.002) and two years (P < 0.001). There were no differences observed in dislocations, aseptic loosening, or periprosthetic joint infections (all P > 0.05).
Conclusions:
Patients treated by nonarthroplasty-trained surgeons experienced higher rates of periprosthetic fractures and aseptic revisions. This data may inform institutional resource allocation, such as dedicated operating room time, for arthroplasty surgeons to be able to provide urgent care for hip fracture patients.
