CARDIOVASCULAR IMPACT OF PERFORMING A TOTAL KNEE ARTHROPLASTY ON A TRAINEE AND SUPERVISING CONSULTANT

Purpose To highlight the cardiovascular responses of a trainee and supervising consultant while performing Total Knee Arthroplasty (TKA) and to demonstrate the impact that supervision has on both their responses. Methods A third year orthopaedic trainee and his consultant underwent non-invasive, continuous cardiac monitoring while performing three primary TKAs. The consultant performed one TKA with the trainee assisting. The trainee then performed two TKAs as primary surgeon. The consultant supervised one TKA scrubbed and the other un-scrubbed. A third person noted the timing of each distinct intra-operative step. A significant peak was defined as an increase in heart rate (HR) of >10%. Results Trainee Significant peaks were only observed when acting as primary surgeon. Peaks occurred during patient positioning, approach, femoral cut, tibial cut, component trial, soft tissue balancing and cementation. Maximum HR was observed during cementation. Scrubbed supervision reduced the magnitude of these peaks and of the maximum HR. Consultant Significant peaks were only observed when supervising the trainee. Timing of these peaks and the maximum HR coincided with those of the trainee. Both were of the higher magnitude when supervising un-scrubbed. Conclusion Significant peaks in HR illustrate the cardiovascular impact of performing TKA. This impact is greatest during the seven definitive steps of the procedure that we have highlighted. This cardiovascular impact of performing TKA reduces as the experience of the surgeon increases. Supervision of a less experienced/trainee surgeon performing a TKA also has a cardiovascular impact on the supervising consultant. To reduce this impact on both trainee and consultant we suggest that supervision, when required, is best provided scrubbed rather than un-scrubbed.