ArticleBMJ surgery, interventions, & health technologies2021
Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study.
Article in BMJ surgery, interventions, & health technologies, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 18 citations in OpenAlex.
- Aligning Priorities of Surgeons and Patients Regarding Obesity and Joint Replacement: Recommendations of the Advisory Committee Codesigning Solutions Regarding Obesity and Arthroplasty Consensus Working Group.Arthroplasty today · 2026Article
- Robotic Assistance for Low-Volume Total Knee Arthroplasty Surgeons Is Associated With Comparable Perioperative Outcomes Related to Those of High-Volume Surgeons Using Conventional Techniques.Arthroplasty today · 2026Article
- Surgical accuracy of open platform image-based robotic-assisted total knee arthroplasty across different implants: a multicentre trial.Arthroplasty (London, England) · 2025Article
- Surgeon Training and Revision Rates After Patellofemoral Arthroplasty.JAMA network open · 2025Article
- Most Military Arthroplasty Surgeons Have a Low Volume Practice in the Military Health System.Arthroplasty today · 2024Article
- Association between surgeon volume and patient outcomes after elective shoulder replacement surgery using data from the National Joint Registry and Hospital Episode Statistics for England: population based cohort study.BMJ (Clinical research ed.) · 2023Article
- How much is enough for total knee arthroplasty?BMJ surgery, interventions, & health technologies · 2021Article
- How much is enough? Finding the minimum annual surgical volume threshold for total knee replacement.BMJ surgery, interventions, & health technologies · 2021Article
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Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThis study aimed to identify a threshold in annual surgeon volume associated with increased risk of revision (for any cause) and deep infection requiring surgery following primary elective total knee arthroplasty (TKA).
designA propensity score matched cohort study.
settingOntario, Canada.
participants169 713 persons who received a primary TKA between 2002 and 2016, with 3-year postoperative follow-up.
main outcome measuresRevision arthroplasty (for any cause), and the occurrence of deep surgical infection requiring surgery.
resultsBased on restricted cubic spline analysis, the threshold for increased probability of revision and deep infection requiring surgery was <70 cases/year. After matching of 51 658 TKA recipients from surgeons performing <70 cases/year to TKA recipients from surgeons with greater than 70 cases/year, patients in the former group had a higher rate of revision (for any cause, 2.23% (95% Confidence Interval (CI) 1.39 to 3.07) vs 1.70% (95% CI 0.85 to 2.55); Hazard Ratio (HR) 1.33, 95% CI 1.21 to 1.47, p<0.0001) and deep infection requiring surgery (1.29% (95% CI 0.44 to 2.14) vs 1.09% (95% CI 0.24 to 1.94); HR 1.33, 95% CI 1.17 to 1.51, p<0.0001).
conclusionsFor primary TKA recipients, cases performed by surgeons who had performed fewer than 70 TKAs in the year prior to the index TKA were at 31% increased relative risk of revision (for any cause), and 18% increased relative risk for deep surgical infection requiring surgery, at 3-year follow-up.
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