High-volume revision surgeons have better outcomes following revision total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 131-136 ◽  
Author(s):  
Mackenzie A. Roof ◽  
Mohamad Sharan ◽  
David Merkow ◽  
James E. Feng ◽  
William J. Long ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
High Volume ◽  
Revision Total Knee Arthroplasty ◽  
Demographic Characteristics ◽  
Academic Medical Centre ◽  
Academic Medical ◽  
Total Knee ◽  
Low Volume ◽  
Centres Of Excellence

Aims It has previously been shown that higher-volume hospitals have better outcomes following revision total knee arthroplasty (rTKA). We were unable to identify any studies which investigated the effect of surgeon volume on the outcome of rTKA. We sought to investigate whether patients of high-volume (HV) rTKA surgeons have better outcomes following this procedure compared with those of low-volume (LV) surgeons. Methods This retrospective study involved patients who underwent aseptic unilateral rTKA between January 2016 and March 2019, using the database of a large urban academic medical centre. Surgeons who performed ≥ 19 aseptic rTKAs per year during the study period were considered HV and those who performed < 19 per year were considered LV. Demographic characteristics, surgical factors, and postoperative outcomes were compared between the two groups. Results A total of 308 rTKAs were identified, 132 performed by HV surgeons and 176 by 22 LV surgeons. The LV group had a significantly greater proportion of non-smokers (59.8% vs 49.2%; p = 0.029). For all types of revision, HV surgeons had significantly shorter mean operating times by 17.75 minutes (p = 0.007). For the 169 full revisions (85 HV, 84 LV), HV surgeons had significantly shorter operating times (131.12 (SD 33.78) vs 171.65 (SD 49.88) minutes; p < 0.001), significantly lower re-revision rates (7.1% vs 19.0%; p = 0.023) and significantly fewer re-revisions (0.07 (SD 0.26) vs 0.29 (SD 0.74); p = 0.017). Conclusion Patients of HV rTKA surgeons have better outcomes following full rTKA. These findings support the development of revision teams within arthroplasty centres of excellence to offer patients the best possible outcomes following rTKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):131–136.

An Academic Orthopaedic Specialty Hospital Provides the Shortest Operative Times within a Single Health System for Primary and Revision Total Knee Arthroplasty

2020 ◽  
Author(s):  
Jenna A. Bernstein ◽  
Stephen Zak ◽  
Ran Schwarzkopf ◽  
Joshua C. Rozell
Keyword(s):  
Total Knee Arthroplasty ◽  
Health System ◽  
Knee Arthroplasty ◽  
High Volume ◽  
Revision Total Knee Arthroplasty ◽  
Health Care Practices ◽  
Specialty Hospital ◽  
Total Knee ◽  
Low Volume ◽  
Surgical Setting

AbstractThe study aimed to optimize value-based health care practices in total joint arthroplasty (TJA), and we need to understand how the surgical setting can influence efficiency of care. While this has previously been investigated, the purpose of this study was to clarify if these findings are generalizable to an institution with an orthopaedic specialty hospital. A retrospective review was conducted of 6,913 patients who underwent primary or revision total knee arthroplasty (TKA) at one of four hospitals within a single, urban, and academic health system: a high volume academic (HVA) hospital, a low volume academic (LVA) hospital, a high volume community (HVC) hospital, or a low volume community (LVC) hospital. Patient demographics were collected in an arthroplasty database, as were operating room (OR) times and several specific time points during the surgery. The HVA (orthopaedic specialty) hospital had the shortest total primary TKA OR times and the LVC that had the longest times (156.69 vs. 174.68, p < 0.0001). The HVA hospital had the shortest total revision TKA OR times, and the LVC had the longest times (158.20 vs. 184.95, p < 0.0001). In our health system, the HVA orthoapedic specialty hospital had the shortest overall OR time, even when compared with the HVC hospital. This is in contradistinction to prior findings that HVC institutions had the shortest OR times in a health system that did not have an orthopaedic specialty hospital. This provides evidence that an orthopaedic specialty hospital can be a model for efficient care, even at an academic teaching institution.

Does Manipulation under Anesthesia Increase the Risk of Revision Total Knee Arthroplasty? A Matched Case Control Study

2017 ◽  
Vol 30 (07) ◽  
pp. 730-733 ◽  
Author(s):  
Todd Pierce ◽  
Kimona Issa ◽  
Anthony Festa ◽  
Anthony Scillia ◽  
Vincent McInerney ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
High Volume ◽  
Revision Total Knee Arthroplasty ◽  
Matched Cohort ◽  
Manipulation Under Anesthesia ◽  
Time Period ◽  
Increased Risk ◽  
Total Knee ◽  
Revision Tka

Manipulation under anesthesia (MUA) can help patients regain an adequate range of motion (ROM) following total knee arthroplasty (TKA). Although there are studies reporting that MUA can assist in improving ROM, there is a paucity of studies regarding whether requiring an MUA is associated with an increased risk of revision. The purpose of this study was to assess the: (1) incidence of revision TKA and (2) outcomes of those undergoing MUA and compare it with a matched cohort who did not require MUA. A prospectively collected database of two high-volume institutions was assessed for patients who required a single MUA following TKA between 2005 and 2011. We found a total of 138 knees with a mean 8.5-year follow-up post-MUA. We compared this with a matched cohort (1:1) who underwent TKA during this same time period but did not require an MUA. Incidence of revision surgery and clinical outcomes were compared between the two cohorts. Within the MUA cohort, nine knees underwent revision, which was similar to the matched cohort that had seven revisions (93 vs. 95%; p = 0.6). The mean KSS-functional (88 vs. 90 points; p = 0.15) and clinical scores (87 vs. 89 points; p = 0.1) were similar between the two cohorts. Undergoing an MUA was not associated with an increased risk of revision TKA. If patients require MUA, they may still achieve satisfactory outcomes. This information can be used in educating patients so they may be able to formulate their expectations following their MUA.

scholarly journals Effect of Hospital and Surgeon Volume on Hospital Costs for Total Knee Arthroplasty

2021 ◽  
Author(s):  
YECHU HUA ◽  
Caroline Thirukumaran ◽  
Yue Li
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Outcomes ◽  
Knee Arthroplasty ◽  
Hospital Volume ◽  
Cost Savings ◽  
High Volume ◽  
Surgeon Volume ◽  
Inpatient Cost ◽  
Total Knee ◽  
Low Volume

Abstract Purpose: Higher hospital or surgeon volume is shown to be associated with better patient outcomes following primary total knee arthroplasty (TKA). However, little research exists on the relationship between hospital and surgeon volume and inpatient costs of TKA. To explore the volume-cost relationship for primary TKA and to determine whether both hospital volume and surgeon volume are independently associated with lower inpatient costs. Methods: Statewide Planning and Research Cooperative System (SPARCS) claims data from the New York State Department of Health were used to identify 102,386 adults who underwent primary TKA from 2013 to 2016. Surgeon volume was defined as the number of TKA cases a surgeon had operated during the previous 365 days of the current case. Hospital volume was defined in a similar way. Hospital and surgeon volumes were categorized as tertile groups. Generalized linear models adjusted for patient, hospital, surgeon, and market covariates.Main Outcome Measures: Inpatient cost calculated as total charges multiplied by cost-to-charge ratios (CCR) and adjusted for inflation.Results: Compared with patients operated by low-volume surgeons in low-volume hospitals, patients of high-volume surgeons in high-volume hospitals had significantly lower inpatient costs (adjusted cost savings = $3,384 per TKA case, 95% confidence interval $3,184 - $3,583, P < 0.001). The inverse volume-cost relationship tended to be stronger in more recent years.Conclusions: TKAs performed at hospitals and by surgeons with higher volumes had significantly lower inpatient costs, especially in more recent years. Regionalization of TKA to high-volume hospitals and surgeons may achieve both better patient outcomes and cost savings.

scholarly journals Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jake von Hintze ◽  
Mika Niemeläinen ◽  
Harri Sintonen ◽  
Jyrki Nieminen ◽  
Antti Eskelinen
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Patient Reported ◽  
Total Knee ◽  
Revision Tka

Abstract Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

Revision Total Knee Arthroplasty

2007 ◽  
Vol 464 ◽  
pp. 146-150 ◽  
Author(s):  
Robert L Barrack ◽  
J Thomas McClure ◽  
Corey F Burak ◽  
John C Clohisy ◽  
Javad Parvizi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Total Knee
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