Backgound: Some studies have explored the influence of theatre staff familiarity on surgical performance, but none have focused specifically on orthopedic surgery. Therefore, we performed a retrospective study aiming to: 1) compare complication rates following total hip arthroplasty (THA) performed at a surgeon's familiar site versus an unfamiliar one, 2) to compare patient-reported outcomes at one year and procedure-related outcomes as well as evaluating other surgical-related factors such as length of stay, operative time.
Hypothesis: Our hypothesis is that performing THA in a familiar versus an unfamiliar environment does not affect the occurrence of early complications.
Methods: Of the 182 cases eligible before propensity score matching, 138 elective THAs performed through the direct anterior approach were retained after matching (69 per group). In the unfamiliar group, the same experienced surgeons performed THAs at a different orthopedic center during the COVID-19 period. The mean age was 70.9 ± 12.8 years, 54.3% (75/138) were women, and the mean BMI was 26.4 ± 4.9 kg/m². Surgical complications were assessed using the CUSUM test.
Results: A total of 12 surgical complications occurred (8.7%,12/138) and no significant difference (familiar group:11.6%, (8/69) versus unfamiliar group: 5.8% (4/69) (p = 0.37)) was observed between groups. Applying the CUSUM test, for peroperative complications, surgical performance remained stable in both groups. For postoperative surgical complications only in the familiar group, the limit has been reached at the 15th procedure and remained stable thereafter. At one year postoperatively, the University of California and Los Angles activity score was significantly higher in the unfamiliar group compared to the familiar group (5.8 vs. 4.8 (p = 0.03)). No statistically significant differences were observed for other patient reported outcomes at one year and for improvement in patient reported outcomes: VAS pain (1.1 vs. 1.1 (p = 0.61)), SF-12 Mental (49.9 vs. 50.3 (p = 0.61)) and Physical (42.8 vs. 46.4 (p = 0.13)), Oxford Hip Score (39.8 vs. 43.0 (p = 0.10)), WOMAC pain (86.6 vs. 89.3 (p = 0.27)) and function (81.9 vs. 88.9 (p = 0.11)). The length of stay (4.8 vs. 6.6 days (p < 0.01)) and operative time (71.1 vs. 79.2 min (p < 0.01)) were significantly lower in the unfamiliar group.
Conclusion: Changing the orthopedic surgeon's environment has no effect on surgical performance when performing elective THA by experienced arthroplasty surgeons.
Level of evidence: III; Case-control study.
