For a study, researchers sought to compare outcomes and complications for patients receiving primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using the American Joint Replacement Registry from 2012 to 2017. From 2012 to 2017, Medicare-eligible instances of primary elective THAs and TKAs reported to the American Joint Replacement Registry database were connected with accessible Centers for Medicaid and Medicare Services claims and National Death Index data. Volume was determined independently for surgeons and hospitals based on the median yearly number of anatomic-specific total arthroplasty surgeries conducted on patients of any age by each surgeon and facility. To establish pairwise comparative surgeon/hospital volume groupings for hip and knee, values were aggregated into a distinct surgeon and hospital volume tertile groupings and then merged.
Low surgeon/low hospital volume was found to have the greatest association with all-cause revisions after THA (OR, 1.63, 95% CI, 1.41-1.89, P<0.0001) and TKA (OR, 1.72, 95% CI, 1.44-2.06, P<0.0001), as well as early revisions due to periprosthetic joint infection after THA (OR, 2.50, 95% CI, 1.53-3.15, P<0.0001) and TKA (OR, 2.18, 95% CI, 1.64-2.89, P<0.0001), risk of early THA instability and dislocation (OR, 2.47, 95% CI, 1.77-3.46, P<0.0001), and 90-day mortality after THA (OR, 1.72, 95% CI, 1.27-2.35, P=0.0005) and TKA (OR, 1.47, 95% CI, 1.15-1.86, P=0.002).
The data showed that THA and TKA problems were much higher in low-volume facilities and done by low-volume surgeons. Given the data from previous literature, including the study, a continued push through healthcare policies and healthcare systems to direct THA and TKA procedures to high-volume centers by high-volume surgeons is warranted because of the obvious reduction in complications and significant costs associated with all-cause revisions, periprosthetic joint infection, instability, and 90-day mortality.