Surgical complications in total knee arthroplasty performed by trainee surgeons under scrubbed attending supervision

Evidence remains inconsistent regarding whether total knee arthroplasty (TKA) performed by trainee surgeons under direct scrubbed attending supervision would be associated with an increased risk of postoperative complications.

This propensity score-matched cohort study analyzed 1,557 primary TKAs performed for knee osteoarthritis. A total of 18 orthopaedic surgeons performed TKAs as trainee surgeons under the direct supervision of a single attending surgeon. Propensity score matching at a 1:4 ratio was conducted using age, sex, body mass index, diabetes mellitus, preoperative hip-knee-ankle angle, and preoperative range of knee motion as covariates, resulting in 259 trainee-performed TKAs matched to 1,036 attending-performed TKAs. The primary outcome was knee-related complications occurring within one year postoperatively.

In the matched cohorts, the trainee group demonstrated a significantly higher incidence of knee-related complications compared with the attending group (10/259 [3.9%] vs. 16/1,036 [1.5%]; p = 0.025). The rate of reoperation involving removal of any component of the knee prosthesis did not differ significantly between groups (5/259 [1.9%] vs. 8/1,036 [0.7%]; p = 0.15).

TKA performed by trainee surgeons under direct scrubbed attending supervision was associated with an increased risk of knee-related complications within one year compared with procedures performed by attending surgeons. These findings suggest that training programs require continuous refinement to improve trainee proficiency while ensuring patient safety.