Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY.
J Arthroplasty. 2019 May;34(5):1003-1007.e3. doi: 10.1016/j.arth.2019.01.023. Epub 2019 Jan 18.
As the clinical and financial environments of total joint arthroplasty (TJA) have evolved over the last several decades so has the role of the surgeon in providing this care to patients. Our objective was to examine current practices and influential factors among fellowship-trained arthroplasty surgeons.
An electronic survey was sent to all surgeons who had completed one of the three high-volume adult reconstruction fellowships from the years 2007-2016. The survey consisted of 34 questions regarding current practice characteristics, case volumes for primary and revision total hip arthroplasty (THA) and total knee arthroplasty (TKA), use of advanced technologies, choice of surgical approach and implant design, factors influencing their choices, and their involvement in implant selection and contract negotiations.
Questionnaires were sent to 53 surgeons; 52 were completed. Sixty percent of respondents performed at least 100 TKAs and 84% performed at least 50 THAs annually. Ninety-four percent use a single company's implant for more than 90% of primary TKA and THA. Fellowship or residency experience was the most significant influence on TKA and THA implant selection for 62% and 45% of surgeons, respectively, while contracts of their current institution were the primary influence for 17% and 12%, respectively. Fifty-five percent of surgeons used some advanced technology of which 16% said this influenced their implant choice. Eighty-six percent perform the majority of cases at centers performing at least 200 TJAs per year, and 39% participate in implant contract negotiations.
Despite changes in the economic environment of TJA, this study demonstrates that experience with a specific implant during training, particularly fellowship, is the most influential factor for implant selection among fellowship-trained arthroplasty surgeons.
过去几十年中，随着全关节置换术（TJA）的临床和财务环境的发展，外科医生在为患者提供这种护理方面的角色也发生了变化。我们的目的是研究 fellowship 培训的关节置换外科医生的当前实践和影响因素。
向 2007-2016 年期间完成三个高容量成人重建 fellowship之一的所有外科医生发送了电子调查。该调查包括 34 个问题，涉及当前实践特征，初次和翻修全髋关节置换术（THA）和全膝关节置换术（TKA）的病例量，使用先进技术，手术入路和植入物设计的选择，影响他们选择的因素，以及他们在植入物选择和合同谈判中的参与情况。
向 53 名外科医生发送了问卷，其中 52 名完成了问卷。60％的受访者每年至少进行 100 例 TKA 手术，84％至少进行 50 例 THA 手术。94％的医生在初次 TKA 和 THA 中使用单一公司的植入物超过 90％。对于 62％和 45％的外科医生， fellowship 或住院医师经历是 TKA 和 THA 植入物选择的最重要影响因素，而其当前机构的合同分别是 17％和 12％的主要影响因素。55％的外科医生使用了一些先进技术，其中 16％表示这影响了他们的植入物选择。86％的外科医生在每年至少进行 200 例 TJA 的中心进行大多数手术，39％的外科医生参与植入物合同谈判。
尽管 TJA 的经济环境发生了变化，但本研究表明，培训期间使用特定植入物的经验，尤其是 fellowship，是 fellowship 培训的关节置换外科医生选择植入物的最具影响力的因素。
