EVALUATION OF INTRAOPERATIVE LIGAMENT INJURY DURING TOTAL KNEE ARTHROPLASTY INVOLVING RESIDENT TRAINING

The purpose of this study is to evaluate if the operative experience level of residents affects the incidence of ligament injuries in patients who have received a total knee arthroplasty. Purpose (a): The focus of this study was to evaluate intraoperative errors in the performance of total knee arthroplasties (TKAs) and compare the error rate of when a junior resident versus a senior resident served as the primary surgeon. Methods (b): A restrospective analysis was performed on all of the TKAs performed by either a junior or senior resident, directly supervised by Russell Wagner, MD, over a four year period of time. This study identified 346 cases, 143 of which were performed by a junior resident and 203 of which were performed by a senior resident. Incidence of injury was also evaluated to determine if intraoperative errors occur as frequently throughout a given rotation or if the occurrences decreased as the rotation progressed. In addition to this, differences between rotations taking place at the beginning of the year and rotations occuring at the end of the year was also investigated. Finally, the last factor analyzed was whether there was a correlation between a patient’s BMI and a ligament injury. Results (c): Of the 346 total knee arthroplasties performed from January 1, 2008 to December 31, 2012, there was an incidence of ligament injury in 7.5% of the cases. The occurrence of injury in which junior residents performed the surgery was 6.3%, compared to 8.3% when senior residents performed the surgery. There were no significant differences between junior or senior residents performing the surgery with regards to intraoperative ligament or tendon injury (p=. 58). The most common ligament injured was the medial collateral in 11 (3%); other ligament injuries included the posterior cruciate ligament in 10 (3%), the patellar tendon in 3 (1%), the popliteus tendon in 2 (.5%), and the lateral collateral ligament and iliotibial band in 1 (.3%). There was no relationship between ligament/tendon damage and in which month of the rotation the surgery was performed. There was also no correlation between rotations during the beginning versus the end of the year. 1 ligament/tendon injury occurred in 89 patients (1%) with a BMI of 30 or less while 25 ligament/tendon injuries occurred in 257 patients (10%) with a BMI of more than 30. This difference was statistically significant (p=.034). Conclusions (d): This analysis suggests that supervised junior residents may safely play a more active role when performing total knee arthroplasty since their involvement is not associated with increased intraoperative ligament or tendon injury. This information may assist attending orthopaedic surgeons and resident training programs in determining the role of junior residents during surgery.