Total Hip Arthroplasty Performed by Fellowship- and Nonfellowship-Trained Surgeons: A Comparison of Indications, Perioperative Management, and Complications.

Abstract

Background: Adult reconstruction fellowship-trained (FT) surgeons undergo an additional year of dedicated subspecialized training. The benefits of fellowship training include a comprehensive education in arthroplasty patient care and contemporary surgical techniques. The purpose of the present study was to compare practice variations between FT and nonfellowship-trained (NFT) surgeons, focusing on indications, perioperative prescribing patterns, and complication rates surrounding total hip arthroplasty (THA).

Methods: An administrative database was used to compare patients who underwent elective THA with FT and NFT surgeons from 2010 to 2020 with a 5-year surveillance period. Sociodemographic factors as well as opioid and anticoagulant prescriptions were compared. Propensity score matching was used to match patients based on age, sex, comorbidity index, region, and insurance status. The 90-day medical complications and 5-year revision rates were compared. In total, 118,423 THAs were identified, with 44,068 THAs in matched fellowship and nonfellowship cohorts.

Results: Patients undergoing THA with FT surgeons had a higher comorbidity burden (the Elixhauser Comorbidity Index: 3.6 versus 3.3, P < 0.001) and prevalence of obesity (12.0 versus 10.9%, P < 0.001). Hip dysplasia, posttraumatic arthritis, and osteonecrosis were more common indications for THA with FT surgeons than NFT surgeons, while osteoarthritis was less common (80.5 versus 82.3%, P < 0.001). The FT surgeons prescribed fewer opioids (127 versus 138 MMEs/patient) and nonaspirin anticoagulants postoperatively (40 versus 51.5%, P < 0.001). Overall complication rates were lower among FT patients (12.4 versus 13.8%, P < 0.001), including dislocation rates (0.9 versus 1.1%, P = 0.002) and 5-year revision rates (3.9 versus 4.3%, P < 0.001).

Conclusions: Adult reconstruction FT surgeons perform THA on more complex patients and deliver lower complication rates while prescribing fewer opioids and less potent anticoagulants in the postoperative period.