Skip to main content

Long Term Clinical Outcome of Total Knee Arthroplasty. The Effect of Surgeon Training and Experience

  • Chapter
Total Knee Arthroplasty

Abstract

Current literature suggests that higher volume Units/Surgeons are usually associated with improved outcomes, due to factors concerning accumulated experience, standardization of protocols and procedures as well as patient-specific particulars. Data widely available from registries of major Healthcare, either Public or Private, Organizations indicate that highly skilled surgeons achieve good outcomes and as they gain experience are better able to select patients suitable for surgery. Accordingly, highly specialized units (training centers, medical schools, centers of Excellence) employing highly qualified and skilled nursing staff, easily achieve higher organizational standards and apply well-established processes, thus diminishing adverse or unpredictable incidents that tend to cause the majority of undesirable outcomes. However, despite these conclusions regarding volume and outcome, little can be said either to promote or renounce the idea of the centralization of knee arthroplasty procedures based on the existing data and the need arises for prospective randomized studies that should address the limitations of the published literature so far.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89A:780–5.

    Article  Google Scholar 

  2. Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, et al. Health-related quality of life after knee replacement. J Bone Joint Surg Am. 1998;80A:163–73.

    Google Scholar 

  3. Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following tricompartmental total knee replacement. A meta-analysis. JAMA. 1994;271:1349–57.

    Article  CAS  PubMed  Google Scholar 

  4. Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, et al. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999;42:1722–8.

    Article  CAS  PubMed  Google Scholar 

  5. Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Belisle P, et al. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum. 2002;46:3327–30.

    Article  PubMed  Google Scholar 

  6. Williams SC, Koss RG, Morton DJ, Loeb JM. Performance of top-ranked heart care hospitals on evidence-based process measures. Circulation. 2006;114:558–64.

    Article  PubMed  Google Scholar 

  7. Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004;86A:1909–16.

    Google Scholar 

  8. Katz JN, Mahomed NN, Baron JA, Barrett JA, Fossel AH, Creel AH, et al. Association of hospital and surgeon procedure volume with patient-centered outcomes of total knee replacement in a population-based cohort of patients age 65 years and older. Arthritis Rheum. 2007;56:568–74.

    Article  PubMed  Google Scholar 

  9. Manley M, Ong K, Lau E, Kurtz SM. Total knee arthroplasty survivorship in the United States Medicare population: effect of hospital and surgeon procedure volume. J Arthroplasty. 2009;24:1061–7.

    Article  PubMed  Google Scholar 

  10. Styron JF, Koroukian SM, Klika AK, Barsoum WK. Patient vs provider characteristics impacting hospital lengths of stay after total knee or hip arthroplasty. J Arthroplasty. 2011;26:1418–26.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Norton EC, Garfinkel SA, McQuay LJ, Heck DA, Wright JG, Dittus R, et al. The effect of hospital volume on the in-hospital complication rate in knee replacement patients. Health Serv Res. 1998;33:1191–210.

    CAS  PubMed Central  PubMed  Google Scholar 

  12. Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg. 2007;94:145–61.

    Article  CAS  PubMed  Google Scholar 

  13. Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991–2010. JAMA. 2012;308:1227–36.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Cram P, Vaughan-Sarrazin MS, Wolf B, Katz JN, Rosenthal GE. A comparison of total hip and knee replacement in specialty and general hospitals. J Bone Joint Surg Am. 2007;89A:1675–84.

    Article  Google Scholar 

  15. Hervey SL, Purves HR, Guller U, Toth AP, Vail TP, Pietrobon R. Provider volume of total knee arthroplasties and patient outcomes in the HCUP-nationwide inpatient sample. J Bone Joint Surg Am. 2003;85A:1775–83.

    Google Scholar 

  16. Taylor Jr DH, Whellan DJ, Sloan FA. Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries. N Engl J Med. 1999;340:293–9.

    Article  PubMed  Google Scholar 

  17. Taylor HD, Dennis DA, Crane HS. Relationship between mortality rates and hospital patient volume for medicare patients undergoing major orthopaedic surgery of the hip, knee, spine, and femur. J Arthroplasty. 1997;12:235–42.

    Article  CAS  PubMed  Google Scholar 

  18. Judge A, Chard J, Learmonth I, Dieppe P. The effects of surgical volumes and training centre status on outcomes following total joint replacement: analysis of the Hospital Episode Statistics for England. J Pub Health. 2006;28:116–24.

    Article  Google Scholar 

  19. Baker P, Dowen D, McMurtry I. The effect of surgeon volume on the need for transfusion following primary unilateral hip and knee arthroplasty. Surgeon. 2011;9:13–7.

    Article  PubMed  Google Scholar 

  20. Bozic KJ, Maselli J, Pekow PS, Lindenauer PK, Vail TP, Auerbach AD. The influence of procedure volumes and standardization of care on quality and efficiency in total joint replacement surgery. J Bone Joint Surg Am. 2010;92A:2643–52.

    Article  Google Scholar 

  21. Kreder HJ, Grosso P, Williams JI, Jaglal S, Axcell T, Wal EK, et al. Provider volume and other predictors of outcome after total knee arthroplasty: a population study in Ontario. Can J Surg. 2003;46:15–22.

    PubMed Central  PubMed  Google Scholar 

  22. Muilwijk J, van den Hof S, Wille JC. Associations between surgical site infection risk and hospital operation volume and surgeon operation volume among hospitals in the Dutch nosocomial infection surveillance network. Infect Control Hosp Epidemiol. 2007;28:557–63.

    Article  PubMed  Google Scholar 

  23. Nunley RM, Lachiewicz PF. Mortality after total hip and knee arthroplasty in a medium-volume university practice. J Arthroplasty. 2003;18:278–85.

    Article  PubMed  Google Scholar 

  24. Ong K, Lau E, Manley M, Kurtz SM. Patient, hospital, and procedure characteristics influencing total hip and knee arthroplasty procedure duration. J Arthroplasty. 2009;24:925–31.

    Article  PubMed  Google Scholar 

  25. Schroer WC, Calvert GT, Diesfeld PJ, Reedy ME, LeMarr AR. Effects of increased surgical volume on total knee arthroplasty complications. J Arthroplasty. 2008;23:61–7.

    Article  PubMed  Google Scholar 

  26. Wei MH, Lin YL, Shi HY, Chiu HC. Effects of provider patient volume and comorbidity on clinical and economic outcomes for total knee arthroplasty: a population-based study. J Arthroplasty. 2010;25:906–12.

    Article  PubMed  Google Scholar 

  27. Yasunaga H, Tsuchiya K, Matsuyama Y, Ohe K. Analysis of factors affecting operating time, postoperative complications, and length of stay for total knee arthroplasty: nationwide web-based survey. J Orthop Sci. 2009;14:10–6.

    Article  PubMed  Google Scholar 

  28. Cram P, Cai X, Lu X, Vaughan-Sarrazin MS, Miller BJ. Total knee arthroplasty outcomes in top-ranked and non-top-ranked orthopedic hospitals: an analysis of Medicare administrative data. Mayo Clin Proc. 2012;87:341–8.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, et al. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg. 2010;130:263–8.

    Article  PubMed  Google Scholar 

  30. Paterson JM, Williams JI, Kreder HJ, Mahomed NN, Gunraj N, Wang X, et al. Provider volumes and early outcomes of primary total joint replacement in Ontario. Can J Surg. 2010;53:175–83.

    PubMed Central  PubMed  Google Scholar 

  31. Alcelik I, Sukeik M, Pollock R, Misra A, Shah P, Armstrong P, et al. Comparison of the minimally invasive and standard medial parapatellar approaches for primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012;20:2502–12.

    Article  CAS  PubMed  Google Scholar 

  32. Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg (Br). 2004;86:682–7.

    Article  CAS  Google Scholar 

  33. Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK. Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplasty. 2012;27:1177–82.

    Article  PubMed  Google Scholar 

  34. Lavernia CJ, Guzman JF. Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty. 1995;10:133–40.

    Article  CAS  PubMed  Google Scholar 

  35. Soohoo NF, Zingmond DS, Lieberman JR, Ko CY. Primary total knee arthroplasty in California 1991 to 2001: does hospital volume affect outcomes? J Arthroplasty. 2006;21:199–205.

    Article  PubMed  Google Scholar 

  36. Yuan Z, Cooper GS, Einstadter D, Cebul RD, Rimm AA. The association between hospital type and mortality and length of stay: a study of 16.9 million hospitalized Medicare beneficiaries. Med Care. 2000;38:231–45.

    Article  CAS  PubMed  Google Scholar 

  37. Khuri SF, Najjar SF, Daley J, Krasnicka B, Hossain M, Henderson WG, et al. Comparison of surgical outcomes between teaching and nonteaching hospitals in the Department of Veterans Affairs. Ann Surg. 2001;234:370–82; discussion 82–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Sharkey PF, Shastri S, Teloken MA, Parvizi J, Hozack WJ, Rothman RH. Relationship between surgical volume and early outcomes of total hip arthroplasty: do results continue to get better? J Arthroplasty. 2004;19:694–9.

    Article  PubMed  Google Scholar 

  39. Hamilton BH, Ho V. Does practice make perfect? Examining the relationship between hospital surgical volume and outcomes for hip fracture patients in Quebec. Med Care. 1998;36:892–903.

    Article  CAS  PubMed  Google Scholar 

  40. Feinglass J, Amir H, Taylor P, Lurie I, Manheim LM, Chang RW. How safe is primary knee replacement surgery? Perioperative complication rates in Northern Illinois, 1993–1999. Arthritis Rheum. 2004;51:110–6.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Schulze Raestrup U, Smektala R. Are there relevant minimum procedure volumes in trauma and orthopedic surgery? Zentralbl Chir. 2006;131:483–92.

    Article  CAS  PubMed  Google Scholar 

  42. Schrader P, Ewerbeck V. Experience in orthopaedic surgery with minimum provider volumes. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2007;78:999–1011.

    Article  CAS  PubMed  Google Scholar 

  43. Luft HS, Hunt SS, Maerki SC. The volume-outcome relationship: practice-makes-perfect or selective-referral patterns? Health Serv Res. 1987;22:157–82.

    CAS  PubMed Central  PubMed  Google Scholar 

  44. Marlow NE, Barraclough B, Collier NA, Dickinson IC, Fawcett J, Graham JC, et al. Centralization and the relationship between volume and outcome in knee arthroplasty procedures. ANZ J Surg. 2010;80:234–41.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nikolaos Roidis MD, DSc .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Roidis, N., Avramidis, G., Kalampounias, P. (2015). Long Term Clinical Outcome of Total Knee Arthroplasty. The Effect of Surgeon Training and Experience. In: Karachalios, T. (eds) Total Knee Arthroplasty. Springer, London. https://doi.org/10.1007/978-1-4471-6660-3_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6660-3_9

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6659-7

  • Online ISBN: 978-1-4471-6660-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics