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Balancing service provision and surgical training is a challenging issue that affects all healthcare systems. A multicentre prospective study of 1501 total hip replacements was undertaken to investigate whether there is an association between surgical outcome and the grade of the operating surgeon, and whether there is any difference in outcome if surgeons' assistants assist with the operation, rather than orthopaedic trainees. The primary outcome measure was the change in the Oxford hip score (OHS) at five years. Secondary outcomes included the rate of revision and dislocation, operating time, and length of hospital stay. There was no significant difference in DeltaOHS or complication rates between operations undertaken by trainers and trainees, or those at which surgeons' assistants and trainees were the assistant. However, there was a significant difference in the duration of surgery, with a mean reduction of 28 minutes in those in which a surgeons' assistant was the assistant. This study provides evidence that total hip replacements can be performed safely and effectively by appropriately trained surgeons in training, and that there are potential benefits of using surgeons' assistants in orthopaedic surgery.

Original publication




Journal article


The Journal of bone and joint surgery. British volume

Publication Date





928 - 934


Botnar Research Centre, Nuffield Department of Orthopaedic Surgery, University of Oxford, Oxford OX3 7LD, UK.


EPOS study group, Humans, Treatment Outcome, Arthroplasty, Replacement, Hip, Prospective Studies, Orthopedics, Clinical Competence, Adult, Aged, Aged, 80 and over, Middle Aged, Surgery Department, Hospital, Quality of Health Care, Female, Male, Clinical Audit, Young Adult