title: A comparison of the results of total hip and knee arthroplasty performed on a teaching service or a private practice service.
abstract: BACKGROUND
  Active participation of residents and fellows in the performance of total hip and total knee arthroplasties may affect the outcomes of these procedures. We evaluated the early clinical results and complications associated with primary total hip and knee arthroplasties at a hospital that had both university teaching and private practice orthopaedic services.
  
  
  METHODS
  We performed a retrospective study on a consecutive series of 347 patients who had undergone 230 total hip and 171 total knee procedures performed by one attending surgeon. One hundred and sixty-nine patients underwent an arthroplasty during which a resident or fellow on a teaching service assisted the attending surgeon; during these procedures, the resident or fellow performed part of the arthroplasty under the direct supervision of the attending surgeon. Subsequently, 178 patients underwent an arthroplasty performed by the same surgeon without resident or fellow participation.
  
  
  RESULTS
  Significantly longer operative times were recorded for both total hip arthroplasty (average, seventy-three compared with sixty-one minutes; p < 0.0001) and total knee arthroplasty (average, eighty compared with seventy-three minutes; p = 0.0028) when the procedures were performed with the participation of residents or fellows. For total hip arthroplasty the complication rates were 8% for the teaching service and 10% for the private practice service, and for total knee arthroplasty they were 3% for each service. With the numbers studied, there were no differences in any clinical outcomes between the groups.
  
  
  CONCLUSIONS
  Teaching and active participation from residents and fellows during total hip and total knee arthroplasty did not have a detrimental effect on the early clinical results, except for a longer surgical time.
authors.affiliation: Stanford University Medical Center, R144, Stanford, CA 94305, USA. swoolson@stanford.edu
authors.forename: Steven T
authors.initials: ST
authors.lastname: Woolson
authors.forename: Michael N
authors.initials: MN
authors.lastname: Kang
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical; D005257:Fellowships and Scholarships; D006617:Hip Dislocation / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D011331:Private Practice; D012189:Retrospective Studies; D013997:Time Factors