Surgical Tribune International

Hip replacement surgery: Practice makes perfect

By Surgical Tribune
August 20, 2020

GOTHENBURG, Sweden: A doctoral thesis at Sahlgrenska Academy at the University of Gothenburg has shown that the results of primary hip replacement surgery improve the more often a surgeon performs this operation annually. However, it did not make a significant difference whether the operating surgeon was a fully trained specialist in orthopaedics or a resident physician being trained as an orthopaedic specialist. The results may help to improve the quality for patients undergoing a hip replacement operation.

The starting point for the research was a discussion on the quality of the results achieved by individual operating surgeons. Some countries have already introduced quality registers for hip replacements, so that individual surgeons get feedback on their own results. The thesis clarified factors that may be important in the creation of a Swedish model.

Much of the research was based on information from public inpatient care in the Västra Götaland region, combined with data from the Swedish Hip Arthroplasty Register. The affected patients had undergone primary hip arthroplasty owing to arthrosis in the hip joint.

Duration of experience not crucial

Analysing 12,100 operations in Västra Götaland between 2007 and 2016, it was found that the more often a surgeon performed the operation, the better the results. The criterion was the proportion of operations where postoperative complications occurred within 90 days. These complications were both medical, such as clots in the leg or lung, or pneumonia, and surgical, owing to, for example, wound infections, hip dislocation, or repeat operations.

“This shows that the healthcare authorities should consider planning for each surgeon to carry out a higher proportion of primary hip replacement operations,” said Per Jolbäck, author of the thesis and a registered orthopaedic nurse at Skaraborg Hospital, in a press release.

“The annual volume of operations per surgeon [...] are pieces of evidence that may help further to improve the situation a bit for patients”

Yet, how long the surgeon had been an orthopaedic surgeon was not a decisive factor in terms of the patients’ health gain and pain level. Patients who were operated on by general practitioners reported slightly lower satisfaction compared with those whose surgeons had the longest specialist experience. However, the differences were not significant. This component study in the thesis covered 6,713 primary hip replacements under the aegis of the health authorities in the Västra Götaland region between 2007 and 2012.

Hopes and fears

“The conclusion is that patients can expect the same benefits in terms of health, pain relief and satisfaction with the operation outcome, irrespective of how long the surgeon has been a specialist in orthopaedics,” added Jolbäck.

Cover illustration of the doctoral thesis by Per Jolbäck. (Image: Pontus Andersson/Pontus Art Production)

The thesis also included an interview study involving 19 doctors—four resident physicians and 15 orthopaedic specialists from 15 hospitals in Sweden. The perceptions of a quality register for surgeon-specific results proved to vary. The respondents expressed both the hope for further development of the profession and the fear that surgeons might encounter misguided criticism.

“The annual volume of operations per surgeon and personal feedback are pieces of evidence that may help further to improve the situation a bit for patients undergoing hip replacements,” concluded Jolbäck.

The doctoral thesis, titled Outcomes following primary total hip arthroplasty: With focus on the surgeon and surgeons’ perceptions about feedback, was published on 5 March 2020 by Sahlgrenska Academy at the University of Gothenburg.


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