Total knee arthroplasty survivorship in the United States Medicare population: effect of hospital and surgeon procedure volume

Abstract

Greater short-term complication risks after total knee arthroplasty (TKA) have been associated with lower hospital and surgeon procedure volume, but the relationship between procedure volume and implant survival is unclear. We examined the association between hospital and surgeon volume and TKA survivorship in the elderly population using 1997 to 2004 Medicare data. Kaplan-Meier method and Cox regression were used to determine implant survivorship and hazard ratios associated with procedure volume at 0.5, 2, 5, and 8 years. The TKA patients in lowest-volume hospitals (1-25 procedures) had a higher risk of revision at 5 and 8 years compared with those operated on in highest-volume hospitals (>200 procedures) (adjusted odds ratio: 1.57 and 1.52, respectively). Surgeon volume was not significantly correlated with implant survivorship. Our findings suggest that TKA patients at low-volume hospitals have a greater revision risk at medium-term follow-up, but not in the short term.