Abstract
Introduction
Previous studies have demonstrated that higher volume hospitals have better outcomes following revision total knee arthroplasty (rTKA), in current literature there are no reports investigating the effect of surgeon volume. The purpose of this study is to investigate if patients of high-volume revision surgeons have better outcomes following rTKA as compared to patients of low volume surgeons.
Methods
This retrospective observational analysis examined the rTKA database at a large urban academic medical center for aseptic, unilateral rTKA between January 2016 and March 2019 with at least 1-year of follow-up. Surgeon operative volume during the same time period was evaluated. Surgeons who performed at least 18 aseptic rTKA per year were considered high volume (HV), whereas surgeons who performed fewer than 18 aseptic rTKA per year were considered low volume (LV). Demographics, surgical factors, and post-operative outcomes were collected and compared between the two cohorts. A post-hoc power analysis was conducted for full revisions (1-ß=0.909, α=0.05).
Results
307 cases were identified: 177 performed by LV surgeons and 130 performed by HV surgeons. The only demographic difference was a greater proportion of non-smokers in the LV cohort (59.4% vs. 50.0%; p=0.031). Patients of HV surgeons were more likely to receive a full revision (64.6% vs. 47.5%; p<0.001). For all revisions, HV surgeons had shorter surgical times by about 17 minutes (p=0.010). For the 168 full revisions (84 HV, 84 LV), patients of HV surgeons had shorter hospital stays (2.92±1.62 vs. 3.57±2.69 days; p=0.048), shorter surgical times (131.42±33.86 vs. 171.65±49.88 minutes; p<0.001), lower re-revision rates (7.1% vs. 19.0%; p=0.038), and fewer re-revisions (0.07±0.26 vs. 0.29±0.74 re-revisions; p=0.018).
Conclusions
Patients of HV revision surgeons have better outcomes following full rTKA. These findings support the development of revision teams within arthroplasty centers of excellence to offer patients the best possible outcomes following rTKA.
