JOA - 2026-06-08 - Journal Article
Outcomes of Total Hip Arthroplasty Based on Surgeon Fellowship and Case Volume.
Katanbaf R, Misch M, Aflatooni JO, Smitterberg CW, Griffin D, Nace J, Delanois R, Mont MA
Topics
Key Takeaway
High-volume fellowship-trained arthroplasty surgeons achieved lower 2-year dislocation rates (1.2% vs. 1.3–1.7%) and lower aseptic revision and PJI rates compared to all non-fellowship-trained volume cohorts, with no NFT volume threshold replicating these outcomes.
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Summary
This study asked whether arthroplasty fellowship training and surgical volume independently or synergistically affect THA outcomes using a national all-payer database of 457,372 primary THAs from 2010–2021. Surgeons were categorized by fellowship type and stratified into high, intermediate, and low volume, with propensity score matching against fellowship-trained cohorts. High-volume fellowship-trained surgeons had lower dislocation rates at 90 days, 1 year, and 2 years, lower aseptic revision rates at 2 years, and lower 2-year PJI rates (P=0.008), while no NFT volume tier matched high-volume FT outcomes.
Key Limitation
Administrative database methodology cannot capture component positioning, implant selection, surgical approach, or patient-reported outcomes, leaving the mechanistic drivers of the fellowship-training advantage unidentified.
Original Abstract
BACKGROUND
Total hip arthroplasty (THA) is a highly successful procedure performed by orthopaedic surgeons of various fellowship training, case volumes, and practice types. This study aimed to compare postoperative outcomes between fellowship-trained (FT) arthroplasty and non-arthroplasty surgeons, stratified by low, intermediate, and high case volume. Outcomes were collected for up to two years postoperatively: 1) mechanical complications (dislocation, aseptic loosening, and periprosthetic fracture (PPFX)), 2) infectious complications (periprosthetic joint infection (PJI) and surgical site infection (SSI)), 3) aseptic revision, and 4) venous thromboembolism (VTE).
METHODS
We retrospectively queried a national all-payer database to identify 457,372 patients who had primary THA between 2010 and 2021. Using National Provider Identifiers, the number of surgeons was categorized by fellowship training (arthroplasty versus non-arthroplasty) and stratified by total case volume during the study period (high, intermediate, and low). Propensity score matching was performed with the respective FT group as the basis of comparison.
RESULTS
High-volume FT surgeons demonstrated lower hip dislocation rates compared with all NFT cohorts at 90 days (0.8 versus 0.9 to 1.2%), one year (1.1 versus 1.2 to 1.5%), and two years (1.2 versus 1.3 to 1.7%) (all P < 0.001). High-volume FT surgeons also had lower aseptic revision rates up to two years (all P < 0.05) and lower PJI rates at two years (P = 0.008). There were no differences observed in PPFX, SSI, VTE, or aseptic loosening. Intermediate- and low-volume FT surgeons similarly demonstrated reduced dislocation rates compared with NFT surgeons, though other complications were comparable (all P > 0.05). There were no NFT surgeon volume threshold achieved outcomes equivalent to high volume FT surgeons.
CONCLUSION
Postoperative THA outcomes were optimized by the combined effects of fellowship training and high surgical volume, underscoring the importance of experience in addition to formal subspecialty training.