Surgical Skills Training for Primary Total Hip Arthroplasty

A total of 483 hips treated by primary total hip arthroplasty (THA) were investigated to evaluate the surgical skill of the performing surgeon. Surgical trainees operated on 259 hips and instructors on 224 hips. The average age of the patients at the time of THA in the trainee and instructor group was 61.9 and 60.8 years old, respectively. The average follow-up duration was 5.1 years. The operative time in the trainee group and instructor group was 87.0 and 73.1 min, respectively (p=0.031). Complications were noted in 11 hips (3.5%) in the trainee group; acetabular fracture, 3 hips; dislocation, 3 hips; femoral artery lacerations that needed repair surgery, 2 hips; sciatic nerve palsy, 2 hips; and skin necrosis, 1 hip. Complication were noted in three hips (1.3%) in the instructor group; femoral fracture, 1 hip; acetabular fracture, 1 hip; dislocation, 1 hip. Complication rate in the trainee group was higher than in the instructor group. The monitored quality of the surgeries performed by trainees and instructors was not significantly different. Poor quality was identified in 14 hips in the trainee group and 6 hips in instructor group. No significant difference was found in the hip score between the trainees and instructors before and after surgery. Revision arthroplasty was defined as the end-point for primary THA. Kaplan-Meier survivorship at 5 years after primary THA was 97.2% in trainee group and 97.3% in the instructor group. Short-term clinical and radiographic results of primary THA in the trainee and instructor groups were considered safe and satisfactory.