title: Do Independent Sector Treatment Centres (ISTC) impact on specialist registrar training in primary hip and knee arthroplasty?
abstract: BACKGROUND
  The introduction of Modernising Medical Careers (MMC) is likely to reduce specialist registrar (SpR) operative experience during higher surgical training (HST). A further negative impact on training by local Independent Sector Treatment Centres (ISTCs) could reduce experience, and thus competence, in primary joint arthroplasty at completion of higher surgical training.
  
  
  METHODS
  Retrospective case note and radiograph analysis of patients receiving primary hip and knee arthroplasty in a teaching hospital, before and after the establishment of a local ISTC. Patients and operative details were recorded from the selected case notes. Corresponding radiographs were assessed and the severity of the disease process assessed.
  
  
  RESULTS
  Fewer primary hip and knee replacements were performed by SpRs in the time period after the establishment of an ISTC.
  
  
  CONCLUSIONS
  ISTCs may adversely affect SpR training in primary joint arthroplasty.
authors.affiliation: Department of Trauma and Orthopaedics, Derbyshire Royal Infirmary, Derby, UK. jclamp@doctors.org.uk
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Clamp
authors.forename: Dean
authors.initials: D
authors.lastname: Baiju
authors.forename: David P
authors.initials: DP
authors.lastname: Copas
authors.forename: James W
authors.initials: JW
authors.lastname: Hutchinson
authors.forename: John M
authors.initials: JM
authors.lastname: Rowles