Impact of resident involvement on complication rates in revision total knee arthroplasty

Objectives: The number of revision total knee arthro-plasty (TKA) procedures continues to rise, a direct consequence of the increase in primary TKA. The num-ber of arthroplasty-trained orthopaedic surgeons has failed to increase at a corresponding rate, and the increased burden will ultimately fall on non-specialized orthopaedists. Resident involvement in primary TKA has not been found to increase postoperative complica-tions, but revision TKA is more complex and the impact of resident involvement has not been well studied.Methods: Using the American College of Surgeons Na-tional Surgical Quality Improvement Program (ACS-NSQIP) database, this study identified 1834 revision TKA procedures between the years 2008 and 2012. Of these procedures, 863 included resident involvement. Demographic information, comorbidities, operative times, length of stay (LOS), and 30-day postoperative complications were stratified by resident and non-resident involvement and analyzed.Results: Resident involvement was not associated with a significant increase in short-term complications. Opera-tive times were significantly longer with resident involvement (147.50 min with resident involvement vs. 124.55 min without a resident, p < 0.001). Length of stay after procedures with resident involvement was higher by 0.34 days, but this did not reach significance (p = 0.061).Conclusion: Resident involvement in revision total knee arthroplasty was associated with a significant increase in operative time; however, there were no significant in-creases in postoperative complication rates within 30 days. These findings support continued resident involve-ment in revision total knee arthroplasty cases and post-operative management.