title: Trends in primary and revision knee arthroplasty among orthopaedic surgeons who take the American Board of Orthopaedics part II exam.
abstract: A certified list of all operative cases performed within a six month period is required of surgeons by the American Board of Orthopaedic Surgery (ABOS) as a prerequisite to taking the Part II Oral Examination. Using the data on these cases collected and maintained by ABOS, this study assessed the influence of prior fellowship training in adult reconstruction on the volume and surgeon-reported complication rate of knee joint arthroplasty cases over time.
  
  
  
  All data were self reported to a secure Internet database (SCRIBE) by candidates who applied to take Part II of the ABOS Examination for the first time. This database was searched for all procedures done between 2003 and 2013 with CPT codes for total and revision knee arthroplasty and removal of knee implant (static or dynamic spacer) to determine procedural volumes and early complication rates among Board-eligible orthopaedic surgeons with and without adult reconstructive fellowship training.
  
  
  
  More than 43,000 knee arthroplasty surgeries were identified. Surgeons who had completed adult reconstruction fellowship training after residency performed 55 % of total knee arthroplasties, averaging 33.5 knee arthroplasties during the six month case-collection period compared to 7.4 procedures by non-fellowship-trained surgeons (p < 0.001). Adult reconstruction fellowship-trained surgeons performed significantly more revisions for infection (average 6.6 versus 2.2 revisions) (p < 0.001). Adult reconstruction fellowship training did not significantly affect complication rates for primary arthroplasty but was associated with an increased complication rate for revisions. Those surgeons who performed more than 100 arthroplasties a year reported significantly fewer complications in primary arthroplasties (12.7 % versus 16.9 %) (p < 0.001). Over time, an increasing percentage of arthroplasties were done by surgeons with adult reconstruction fellowship training.
  
  
  
  Adult reconstruction fellowship-trained surgeons performed an increasing number of primary and more complex knee arthroplasties from 2003 to 2013. Surgeons who perform a larger volume of knee arthroplasty surgeries report fewer early complications than surgeons with fewer cases.
  
  
  
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authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA. aeslampo@med.umich.edu.
authors.forename: Aidin Eslam
authors.initials: AE
authors.lastname: Pour
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bradbury
authors.affiliation: Department of Orthopaedic Surgery, University of San Francisco, San Francisco, CA, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Horst
authors.affiliation: American Board of Orthopaedic Surgery, 400 Silver Cedar Ct # 100, Chapel Hill, NC, 27514, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Harrast
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
authors.forename: Greg A
authors.initials: GA
authors.lastname: Erens
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Roberson
mesh_terms: D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000639:trends*; D002568:Certification; D016208:Databases, Factual; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data; D006801:Humans; D000072161:Orthopedic Surgeons / Q000193:education / Q000639:trends*; D009985:Orthopedics / Q000193:education; D012086:Reoperation / Q000639:trends*; D014481:United States
keywords: ABOS Part II exam; Board certification; Complications; Fellowship training; Knee; Revision arthroplasty; Total knee arthroplasty