Does surgeon experience affect patient-reported outcomes 1 year after primary total hip arthroplasty?

Figures & data

Flow chart.

Table 1. Patient characteristics and surgical data divided into subgroups based on surgeons’ experience at the time of surgery

	Trainees (n = 538)	< 8 years (n = 2,181)	8–15 years (n = 984)	> 15 years (n = 3,010)	All (n = 6,713)	p-value
Age, years, mean
All (SD)	73 (8)	71 (9)	69 (10)	67 (11)	69 (10)	< 0.001
Missing, n (%)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Gender, n (%)						0.6
Male	215 (40)	935 (43)	424 (43)	1,264 (42)	2,838 (42)
Missing, n (%)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
BMI, mean						0.2
All (SD)	27 (4)	28 (5)	27 (4)	27 (5)	27 (5)
Missing, n (%)	150 (28)	527 (24)	287 (29)	854 (28)	1,818 (27)
ASA classification, n (%)						< 0.001
I	91 (17)	580 (27)	326 (33)	882 (29)	1,879 (28)
II	320 (60)	1,197 (55)	510 (52)	1,523 (51)	3,550 (53)
III/IV	85 (16)	279 (13)	91 (9)	258 (9)	713 (11)
Missing	42 (8)	125 (6)	57 (6)	347 (12)	571 (9)
Diagnosis, n (%)						< 0.001
Primary OA	536 (100)	2,136 (98)	964 (98)	2,893 (96)	6,529 (97)
Secondary OA	2 (0)	45 (2)	20 (2)	116 (4)	183 (3)
Missing	0 (0)	0 (0)	0 (0)	1 (0.0)	1 (0)
Fixation technique, n (%)						< 0.001
Cemented	481 (90)	1,749 (80)	764 (78)	2,034 (68)	5,028 (75)
Uncemented	29 (5)	237 (11)	126 (13)	567 (19)	959 (14)
Hybrids	5 (1)	62 (3)	21 (2)	82 (3)	170 (3)
Reverse hybrids	23 (4)	133 (6)	72 (7.3)	322 (11)	550 (8)
Missing	0 (0)	0 (0)	1 (0)	5 (0)	6 (0)
Charnley classification at 1 year, n (%)						< 0.001
A	229 (43)	925 (42)	464 (47)	1,406 (47)	3,024 (45)
B	52 (10)	179 (8)	87 (9)	307 (10)	625 (9)
C	257 (48)	1,077 (49)	433 (44)	1,297 (43)	3,064 (46)
Missing	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)

Kruskal–Wallis H test for age, BMI, ASA classification, diagnosis, fixation technique, and Charnley classification at 1-year follow-up, and Pearson’s chi-square test for sex. SD = standard deviation. BMI = body mass index. OA = osteoarthritis. ASA = American Society of Anesthesiologists.

Table 2. PROs divided into subgroups based on surgeons’ experience at the time of surgery

	Trainees	< 8 years	8–15 years	> 15 years	All	p-value
EQ-5D index
preoperative	0.41 (0.31)	0.41 (0.31)	0.41 (0.31)	0.43 (0.31)	0.42 (0.31)	0.05
1-year postop.	0.75 (0.24)	0.76 (0.25)	0.77 (0.25)	0.77 (0.24)	0.77 (0.24)	0.005
change	0.34 (0.35)	0.35 (0.34)	0.36 (0.34)	0.34 (0.34)	0.35 (0.34)	0.7
EQ VAS
preoperative	56 (22)	56 (21)	57 (21)	57 (21)	57 (21)	0.2
1-year postop.	74 (20)	74 (21)	75 (20)	76 (20)	75 (20)	0.02
change	18 (23)	18 (23)	18 (22)	19 (23)	18 (23)	0.9
Pain VAS
preoperative	61 (16)	61 (16)	61 (16)	60 (17)	61 (16)	0.6
1-year postop.	17 (19)	15 (19)	14 (18)	15 (18)	15 (18)	0.002
change	44 (23)	46 (23)	47 (22)	45 (23)	46 (23)	0.3
Satisfaction VAS
1-year postop.	21 (23)	19 (22)	18 (21)	18 (22)	19 (22)	< 0.001

Kruskal–Wallis H test used for all variables. All values are presented as mean value and standard deviation (SD). VAS = visual analogue scale.

Table 3. Linear regression analysis of PROs

	Simple sz-coefficient (95% CI)	Multivariable^a sz-coefficient (95% CI)
EQ-5D index
15 years	Reference	Reference
8–15 years	0.00 (–0.02 to 0.02)	–0.01 (–0.03 to 0.01)
8 years	–0.01 (–0.03 to 0.00)	–0.01 (–0.03 to 0.01)
trainee	–0.02 (–0.05 to 0.00)	–0.02 (–0.05 to 0.00)
EQ VAS
15 years	Reference	Reference
8–15 years	–0.05 (–1.50 to 1.41)	–0.82 (–2.47 to 0.83)
8 years	–1.29 (–2.40 to –0.17)	–0.45 (–1.71 to 0.80)
trainee	–1.79 (–3.65 to 0.07)	–0.91 (–3.03 to 1.21)
Pain VAS
15 years	Reference	Reference
8–15 years	–0.14 (–1.46 to 1.18)	0.49 (–1.06 to 2.05)
8 years	0.84 (–0.17 to 1.85)	0.78 (–0.41 to 1.96)
trainee	2.37 (0.69 to 4.05)	1.88 (–0.12 to 3.88)
Satisfaction VAS
15 years	Reference	Reference
8–15 years	–0.22 (–1.81 to 1.37)	0.55 (–1.32 to 2.42)
8 years	1.58 (0.37 to 2.80)	0.72 (–0.70 to 2.13)
trainee	3.61 (1.58 to 5.63)	2.64 (0.24 to 5.03)

a Adjusted for age, sex, BMI, ASA classification, diagnosis, and Charnley classification at 1 year. CI = confidence intervals, BMI = body mass index, ASA = American Society of Anesthesiologists, VAS = visual analogue scale. Reference is surgeon with >15 years’ experience as orthopedic specialists.