Evidence map›Paper›PMID 40066653›Full record

SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025

Low confidence in the cumulative evidence for the existence of a volume-outcome relationship after revision total knee replacement: A systematic review and meta-analysis.

Alexander H Matthews, Thomas Stringfellow, Hayley Redman, William K Gray, Jonathan P Evans, Jonathan T Evans, Sarah E Lamb, Tim Briggs, Andrew Price, Andrew D Toms

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Alexander H MatthewsGetting It Right First Time Programme, NHS England, London, UK.ORCID http://orcid.org/0000-0002-1606-5840
Thomas StringfellowGetting It Right First Time Programme, NHS England, London, UK.
Hayley RedmanUniversity of Exeter, Exeter, UK.
William K GrayGetting It Right First Time Programme, NHS England, London, UK.
Jonathan P EvansRoyal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
Jonathan T EvansRoyal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
Sarah E LambUniversity of Exeter, Exeter, UK.
Tim BriggsGetting It Right First Time Programme, NHS England, London, UK.
Andrew PriceNuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Andrew D TomsRoyal Devon University Healthcare NHS Foundation Trust, Exeter, UK.

Funding

NHS England
6 · The paper itself

Abstract

purposeThis systematic review and meta-analysis aimed to establish the relationship between the number of procedures a hospital or surgeon performs with outcomes following revision knee replacement (RevKR).

methodsMEDLINE and Embase were searched using Ovid silver platter up to December 2024 for randomised controlled trials and cohort studies that reported RevKR volumes, in at least two categories, performed by hospitals and surgeons and their relationship to patient and provider level outcomes. The primary outcome was re-revision rate. Secondary outcomes included mortality, post-operative complications, patient-reported outcomes measures (PROMs), emergency readmissions and hospital length of stay. The effect estimates were pooled and plotted using a random-effects, non-linear dose-response meta-analysis (DRMA). Where limitations in the data prohibited DRMA, a narrative approach was utilised. ROBINS-I and the GRADE approach were used to assess the risk of bias and the confidence in the cumulative evidence, respectively.

resultsA total of 10 cohort studies with data from 1993 to 2021 were included. The confidence in the cumulative evidence exploring the relationship between surgeon/hospital volume and all outcomes after RevKR was very low. An inconsistent relationship was seen between hospital and surgeon volume and re-revision at any point. There was a non-linear dose-response relationship between higher hospital volume and lower odds of adverse post-operative events (p < 0.05, n = 3 studies, n = 35,524 patients). There was no association between increased surgeon volumes and improvements in PROMs (n = 2 studies, n = 2289).

conclusionThere is a lack of high-quality studies establishing the relationship between the number of procedures a hospital or surgeon performs and outcomes following RevKR. Studies are limited to observational designs and are difficult to effectively power due to the rarity of outcomes. Pooling data from multiple studies provides valuable insights but highlights significant heterogeneity and limitations in the existing literature. LEVEL OF EVIDENCE: Level III, systematic review-lowest level of evidence analysed-was from retrospective cohort study of prospectively collected data.

Indexed as

Arthroplasty, Replacement, KneeHospitals, High-VolumeHospitals, Low-VolumeReoperationHumansLength of StayPatient ReadmissionPatient Reported Outcome MeasuresPostoperative Complicationscomplicationshospital volumere‐revisionrevision total knee replacementsurgeon volume

Identifiers

PMID40066653
PMCPMC12205428

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.