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Impact of Fellow Involvement on Patient Outcomes in Total Hip and Knee Arthroplasty
Luke Zabawa1, Noah Baker2, Cecilia Manganello1
1Department of Orthopaedic Surgery, The Carrell Clinic, Dallas, Texas.
Background:
Total joint arthroplasty fellowships are increasingly common for surgical specialization, yet evidence regarding the impact of fellow involvement on patient-reported outcome measures (PROMs) and operative efficiency remains limited. This study evaluated if an arthroplasty fellow affects clinical outcomes or surgical theater efficiency compared to an attending surgeon operating alone.
Methods:
A retrospective cohort study was conducted on 450 patients who underwent elective primary unilateral total hip arthroplasty (n = 251) or total knee arthroplasty (n = 199) between August 2023 and March 2025 at a single institution. Patients were divided into two groups: those where a fellow was actively involved and those performed by the attending surgeon alone. The primary outcomes included surgical efficiency (total tourniquet or operative time) and postoperative clinical outcomes, including 90-day readmissions, Surgical Site Infections, and revision rates. The secondary outcomes included PROMs (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Patient-Reported Outcomes Measurement Information System, and visual analog scale) collected preoperatively and up to one year postoperatively.
Results:
For total knee arthroplasty, operative times were comparable (54.0 nonfellow versus 56.4 minutes for fellow; P = 0.131). In total hip arthroplasty, fellow involvement initially increased operative time during the first rotation (84.5 versus 75.4 minutes; P = 0.012), but this difference resolved by the second rotation (78.3 minutes; P = 0.149). There were no statistically significant differences observed in any PROMs, including 1-year Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (P = 0.115) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (P = 0.869), or in resting and active visual analog scale pain scores at any time point (P > 0.05).
Conclusions:
Fellow involvement in primary total joint arthroplasty does not compromise operative efficiency or patient outcomes. In conclusion, our data support the continued mentorship of fellows within high-volume practices without compromising clinical outcomes or senior surgeon workflow.