Thursday, September 19, 2013

Experience lessens failure rate in joint replacement

Influence of Hospital Volume on Revision Rate After Total Knee Arthroplasty with Cement

This study concerned 37,381total knee arthroplasties that were reported to the Norwegian Arthroplasty Register from 1994 to 2010.

The rate of prosthetic failure at ten years was 7.5% for hospitals with an annual volume of one to twenty-four procedures and 4.5% for hospitals with an annual volume of ≥150 procedures. There was a significantly lower risk of revision for hospitals with an annual volume over 100 procedures compared with hospitals with an annual volume of one to twenty-four procedures.

The authors point out that prior reports have associated lower hospital and surgeon volume with higher short-term risk of complications, adverse outcomes and mortality.

It is not clear whether the failure rates continue to drop with even higher annual procedure volumes.

As the authors point out, the "benefits of high volume probably include not only improved surgical technique but also a better understanding of the importance of patient selection and the indications for surgery."

While these results concern total knee arthroplasty, we note that shoulder arthroplasty is no simpler than total knee arthroplasty; thus it is likely that the same phenomena and perhaps the same volume thresholds exist for shoulder joint replacement.

Similar results were recently reported in Impact of Hospital Volume on Postoperative Complications and In-Hospital Mortality After Musculoskeletal Tumor Surgery: Analysis of a National Administrative Database.

It appears that experience is the great teacher.

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