SynthesisBMJ open2021
Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis.
Synthesis in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed.
- Comparison of orthopaedic specialty registrar training opportunities in trusts with and without an elective surgical hub: a review of administrative data.Annals of the Royal College of Surgeons of England · 2026Article
- Association between surgeon training grade and the risk of revision following total knee replacement: An analysis of National Joint Registry data.PLoS medicine · 2025Observational
- The association between surgeon grade and radiographic implant alignment following oxford unicompartmental knee replacement.Archives of orthopaedic and trauma surgery · 2025Article
- The risk of revision surgery after trainee-led primary total hip replacement.Annals of the Royal College of Surgeons of England · 2025Article
- Association between surgeon training grade and the risk of revision following unicompartmental knee replacement: An analysis of National Joint Registry data.PLoS medicine · 2024Observational
- Patient outcomes, efficiency, and adverse events for elective hip and knee replacement in private and NHS hospitals: a population-based cohort study in England.The Lancet regional health. Europe · 2024Article
- A Multi-factor Analysis of Revision in Total Hip Replacement Using the Collarless-Polished-Tapered Stems with Different Cups.Orthopaedic surgery · 2023Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
objectiveTo investigate the association between surgeon grade (trainee vs consultant) and implant survival following primary hip and knee replacement.
designA systematic review and meta-analysis of observational studies. DATA SOURCES: MEDLINE and Embase from inception to 6 October 2021.
settingUnits performing primary hip and/or knee replacements since 1990.
participantsAdult patients undergoing either a primary hip or knee replacement, predominantly for osteoarthritis.
interventionWhether the surgeon recorded as performing the procedure was a trainee or not. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was net implant survival reported as a Kaplan-Meier survival estimate. The secondary outcome was crude revision rate. Both outcomes were reported according to surgeon grade.
resultsNine cohort studies capturing 4066 total hip replacements (THRs), 936 total knee replacements (TKRs) and 1357 unicompartmental knee replacements (UKRs) were included (5 THR studies, 2 TKR studies and 2 UKR studies). The pooled net implant survival estimates for THRs at 5 years were 97.9% (95% CI 96.6% to 99.2%) for trainees and 98.1% (95% CI 97.1% to 99.2%) for consultants. The relative risk of revision of THRs at 5 and 10 years was 0.88 (95% CI 0.46 to 1.70) and 0.68 (95% CI 0.37 to 1.26), respectively. For TKRs, the net implant survival estimates at 10 years were 96.2% (95% CI 94.0% to 98.4%) for trainees and 95.1% (95% CI 93.0% to 97.2%) for consultants. We report a narrative summary of UKR outcomes.
conclusionsThere is no strong evidence in the existing literature that trainee surgeons have worse outcomes compared with consultants, in terms of the net survival or crude revision rate of hip and knee replacements at 5-10 years follow-up. These findings are limited by the quality of the existing published data and are applicable to countries with established orthopaedic training programmes. PROSPERO REGISTRATION NUMBER: CRD42019150494.
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