The effect of hospital case volume on re-revision following revision total knee arthroplasty: a national study using the Scottish Arthroplasty Project dataset. (1st April 2021)

• Record Type: Journal Article
• Authors: Yapp, Liam Z.; Walmsley, Phil J.; Moran, Matthew; Clarke, Jon V.; Simpson, A. Hamish R. W.; Scott, Chloe E. H.
• Is Part Of: Bone & joint journal. Volume 103B:Number 4(2021)
• Page Start: 602
• Page End: 609
• Publication Date: 2021-04-01
• Subjects: Revision -- Knee -- Arthroplasty -- Survival; revision total knee arthroplasty (RTKA) -- infection -- arthroplasty -- knees -- retrospective analysis -- comorbidities -- knee arthroplasty -- Cox proportional hazard regression -- postoperative infection -- primary TKAs; Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; 617.47005
• DOI: 10.1302/0301-620X.103B4.BJJ-2020-1901.R1
• Languages: English
• ISSNs: 2049-4394

Abstract

Abstract : Aims: The aim of this study was to measure the effect of hospital case volume on the survival of revision total knee arthroplasty (RTKA). Methods: This is a retrospective analysis of Scottish Arthroplasty Project data, a nationwide audit which prospectively collects data on all arthroplasty procedures performed in Scotland. The primary outcome was RTKA survival at ten years. The primary explanatory variable was the effect of hospital case volume per year on RTKA survival. Kaplan-Meier survival curves were plotted with 95% confidence intervals (CIs) to determine the lifespan of RTKA. Multivariate Cox proportional hazards were used to estimate relative revision risks over time. Hazard ratios (HRs) were reported with 95% CI, and p-value < 0.05 was considered statistically significant. Results: From 1998 to 2019, 8, 301 patients (8, 894 knees) underwent RTKA surgery in Scotland (median age at RTKA 70 years (interquartile range (IQR) 63 to 76); median follow-up 6.2 years (IQR 3.0 to 10.2). In all, 4, 764 (53.6%) were female, and 781 (8.8%) were treated for infection. Of these 8, 894 knees, 957 (10.8%) underwent a second revision procedure. Male sex, younger age at index revision, and positive infection status were associated with need for re-revision. The ten-year survival estimate for RTKA was 87.3% (95% CI 86.5 to 88.1). Adjusting for sex, age, surgeon volume, and indication for revision, high hospital case volume was significantly associated with lower risk of re-revision (HR 0.78 (95% CI 0.64 to 0.94, p < 0.001)). The risk of re-revision steadily declined in centres performing > 20 cases per year; risk reduction was 16% with > 20 cases; 22% with > 30 cases; and 28% with > 40 cases. The lowest level of risk was associated with the highest volume centres. Conclusion: The majority of RTKA in Scotland survive up to ten years. Increasing yearly hospital case volume above 20 cases is independently associated with a significant risk reduction of re-revision. Development of high-volume tertiary centres may lead to an improvement in the overall survival of RTKA. Cite this article: Bone Joint J 2021;103-B(4):602–609.