Background: Active participation of residents and fellows in the
performance of total hip and total knee arthroplasties may affect the outcomes
of these procedures. We evaluated the early clinical results and complications
associated with primary total hip and knee arthroplasties at a hospital that
had both university teaching and private practice orthopaedic services.
Methods: We performed a retrospective study on a consecutive series
of 347 patients who had undergone 230 total hip and 171 total knee procedures
performed by one attending surgeon. One hundred and sixty-nine patients
underwent an arthroplasty during which a resident or fellow on a teaching
service assisted the attending surgeon; during these procedures, the resident
or fellow performed part of the arthroplasty under the direct supervision of
the attending surgeon. Subsequently, 178 patients underwent an arthroplasty
performed by the same surgeon without resident or fellow participation.
Results: Significantly longer operative times were recorded for both
total hip arthroplasty (average, seventy-three compared with sixty-one
minutes; p < 0.0001) and total knee arthroplasty (average, eighty compared
with seventy-three minutes; p = 0.0028) when the procedures were performed
with the participation of residents or fellows. For total hip arthroplasty the
complication rates were 8% for the teaching service and 10% for the private
practice service, and for total knee arthroplasty they were 3% for each
service. With the numbers studied, there were no differences in any clinical
outcomes between the groups.
Conclusions: Teaching and active participation from residents and
fellows during total hip and total knee arthroplasty did not have a
detrimental effect on the early clinical results, except for a longer surgical
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.