title: Do trainee surgeons have an adverse effect on the outcome after total hip arthroplasty?: a ten-year review.
abstract: OBJECTIVE
  The long-term functional outcome of total hip arthroplasty (THA) performed by trainees is not known. A multicentre retrospective study of 879 THAs was undertaken to investigate any differences in outcome between those performed by trainee surgeons and consultants.
  
  
  METHODS
  A total of 879 patients with a mean age of 69.5 years (37 to 94) were included in the study; 584 THAs (66.4%) were undertaken by consultants, 138 (15.7%) by junior trainees and 148 (16.8%) by senior trainees. Patients were scored using the Harris Hip Score (HHS) pre-operatively and at one, three, five, seven and ten years post-operatively. Surgical outcome, complications and survival were compared between groups. The effect of supervision was determined by comparing supervised and unsupervised trainees. A primary univariate analysis was used to select variables for inclusion in multivariate analysis.
  
  
  RESULTS
  There was no evidence that the grade of the surgeon had a significant effect on the survival of the patients or the rate of revision (p = 0.987 and 0.405, respectively) up to 12 years post-operatively. There was no significant difference in post-operative functional HHS or total HHS among consultants, junior and seniors up to ten years post-operatively (p = 0.401 and 0.331), respectively. There was no significant difference in hospital stay (p = 0.855) between different grades of surgeons. There was no evidence that the level of supervision had an effect on the survival of the patients or the rate of revision (p = 0.837 and 0.203, respectively) up to 12 years post-operatively. There was no significant difference between supervised and unsupervised trainee groups in post-operative functional HHS or total HHS up to ten years post-operatively (p = 0.213 and 0.322, respectively). There was no significant difference in the mean hospital stay between supervised and unsupervised trainees (p = 0.908).
  
  
  CONCLUSIONS
  This study suggests that when trainees are appropriately supervised, they can obtain results comparable with those of their consultant colleagues when performing THA.
authors.affiliation: Ninewells Hospital, Dundee DD1 9SY, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Reidy
authors.affiliation: Ninewells Hospital, Dundee DD1 9SY, UK.
authors.forename: A
authors.initials: A
authors.lastname: Faulkner
authors.affiliation: Ninewells Hospital, Dundee DD1 9SY, UK.
authors.forename: B
authors.initials: B
authors.lastname: Shitole
authors.affiliation: Ninewells Hospital, Dundee DD1 9SY, UK.
authors.forename: B
authors.initials: B
authors.lastname: Clift
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000193:education* / Q000592:standards*; D002983:Clinical Competence; D003253:Consultants; D004503:Education, Medical, Graduate; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hip; THA; arthroplasty; outcomes; training