Surgeon Experience Influences Posterior Approach Total Hip Arthroplasty Dislocation Risk, But It Is Mitigated by
Alex M Hollenberg1, Gireesh B Reddy1, Madeline Sauer1
1Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri.
Background:
Dislocation remains a common complication after total hip arthroplasty (THA). While higher annual surgical volume has been associated with lower dislocation rates, the influence of surgeon experience is poorly understood. We evaluated whether early-career surgeons have higher rates of dislocation compared to experienced career surgeons and whether enabling technology, specifically computer navigation or robotic assistance (RA), mitigates this risk.
Methods:
A retrospective review of 5,516 consecutive primary THAs was performed at a single academic institution between June 1, 2018, and November 1, 2024. Patients were ≥ 18 years, had primary osteoarthritis, and underwent posterior approach (PA) or direct anterior approach (DAA) THA. Surgeons were categorized as early career (n = 6) or experienced career (n = 4) based on having fewer or more than five years in practice, respectively. Demographics, history of lumbar spinal fusion, use of enabling technology, surgical variables, and postoperative dislocations and revisions were collected from the electronic medical record and telephone follow-up. Multivariate logistic regressions were performed to identify factors associated with dislocation.
Results:
Dislocation was more common after PA compared to DAA THA (1.7 versus 0.5%, P < 0.001). Experience did not affect the DAA dislocation rate (early career 0.2 versus experienced career 0.6%, P = 0.311). For manual PA THA, early-career surgeons had a higher dislocation rate than experienced-career surgeons (4.5 versus 1.2%, P < 0.001). Early-career surgeons using RA for PA THA had a dislocation rate comparable to experienced-career surgeons using manual technique (0.3 versus 1.2%, P = 0.240) and to DAA THA (P > 0.999). On multivariate analysis, RA was protective against dislocation for early-career surgeons (odds ratio 0.08, 95% confidence interval 0.004 to 0.42, P = 0.001).
Conclusions:
Early-career surgeons had a higher dislocation rate after manual PA THA compared to experienced-career surgeons. Use of RA reduced PA dislocation risk to levels comparable to those of experienced-career surgeons and those performing DAA THA.
