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. 2014 Aug;85(4):342-7.
doi: 10.3109/17453674.2014.920990. Epub 2014 May 21.

Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals

Mona Badawy  1 , Birgitte Espehaug, Kari Indrekvam, Leif I Havelin, Ove Furnes
Affiliations

Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals

Mona Badawy et al. Acta Orthop. 2014 Aug.

Abstract

Background and purpose: Some studies have found high complication rates and others have found low complication rates after unicompartmental knee arthroplasty (UKA). We evaluated whether hospital procedure volume influences the risk of revision using data from the Norwegian Arthroplasty Register (NAR).

Materials and methods: 5,791 UKAs have been registered in the Norwegian Arthroplasty Register. We analyzed the 4,460 cemented medial Oxford III implants that were used from 1999 to 2012; this is the most commonly used UKA implant in Norway. Cox regression (adjusted for age, sex, and diagnosis) was used to estimate risk ratios (RRs) for revision. 4 different volume groups were compared: 1-10, 11-20, 21-40, and > 40 UKA procedures annually per hospital. We also analyzed the reasons for revision.

Results and interpretation: We found a lower risk of revision in hospitals performing more than 40 procedures a year than in those with less than 10 UKAs a year, with an unadjusted RR of 0.53 (95% CI: 0.35-0.81) and adjusted RR of 0.59 (95% CI: 0.39-0.90). Low-volume hospitals appeared to have a higher risk of revision due to dislocation, instability, malalignment, and fracture than high-volume hospitals.

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Figures

Figure 1.
Figure 1.
4,460 unicompartmental knee arthroplasties (UKAs) were selected for inclusion in this study. Knees that were treated with total knee arthroplasty (TKA), lateral UKA, uncemented UKA, cemented UKA without antibiotics, and brands other than Oxford III were excluded.
Figure 2.
Figure 2.
Bar graph showing the change in hospital procedure volumes over time, with the 3 columns indicating the years 2000, 2005, and 2010.
Figure 3.
Figure 3.
Cox-adjusted survival curve for cemented unicompartmental knee arthroplasty in Norway from 1999 to 2012, with revision for any reason as endpoint. The results of Cox regression analysis were adjusted for age, sex, and diagnosis. The results are shown for the 4 different hospital volume groups described in the text.
See this image and copyright information in PMC

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