title: Trends in Primary and Revision Hip Arthroplasty Among Orthopedic Surgeons Who Take the American Board of Orthopedics Part II Examination.
abstract: A certified list of all operative cases performed within a 6-month period is a required prerequisite for surgeons taking the American Board of Orthopaedic Surgery Part II oral examination. Using the American Board of Orthopaedic Surgery secure Internet database database containing these cases, this study (1) assessed changing trends for primary and revision total hip arthroplasty (THA) and (2) compared practices and early postoperative complications between 2 groups of examinees, those with and without adult reconstruction fellowship training.
  
  
  
  Secure Internet database was searched for all 2003-2013 procedures with a Current Procedural Terminology code for THA, hip resurfacing, hemiarthroplasty, revision hip arthroplasty, conversion to THA, or removal of hip implant (Girdlestone, static, or dynamic spacer).
  
  
  
  Adult reconstruction fellowship-trained surgeons performed 60% of the more than 33,000 surgeries identified (average 28.1) and nonfellowship-trained surgeons performed 40% (average 5.2) (P < .001). Fellowship-trained surgeons performed significantly more revision surgeries for infection (71% vs 29%)(P < .001). High-volume surgeons had significantly fewer complications in both primary (11.1% vs 19.6%) and revision surgeries (29% vs 35.5%) (P < .001). Those who passed the Part II examination reported higher rates of complications (21.5% vs 19.9%).
  
  
  
  In early practice, primary and revision hip arthroplasties are often performed by surgeons without adult reconstruction fellowship training. Complications are less frequently reported by surgeons with larger volumes of joint replacement surgery who perform either primary or more complex cases. Primary hip arthroplasty is increasingly performed by surgeons early in practice who have completed an adult reconstructive fellowship after residency training. This trend is even more pronounced for more complex cases such as revision or management of infection.
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Aidin
authors.initials: A
authors.lastname: Eslam Pour
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bradbury
authors.affiliation: Department of Orthopaedic Surgery, University of San Francisco, San Francisco, California.
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Horst
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco.
authors.forename: John J
authors.initials: JJ
authors.lastname: Harrast
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia.
authors.forename: Greg A
authors.initials: GA
authors.lastname: Erens
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia.
authors.forename: James R
authors.initials: JR
authors.lastname: Roberson
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods / Q000639:trends*; D016208:Databases, Factual; D005257:Fellowships and Scholarships; D062785:Hemiarthroplasty / Q000379:methods / Q000639:trends*; D006801:Humans; D007396:Internship and Residency; D000072161:Orthopedic Surgeons; D009985:Orthopedics / Q000193:education*; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D012086:Reoperation / Q000379:methods / Q000639:trends*; D012955:Societies, Medical; D014481:United States; D000078329:Workforce
keywords: ABOS part II examination; complications; fellowship training; hip arthroplasty; orthopedic surgeons; revision hip arthroplasty