Evidence map›Paper›PMID 40351240›Full record

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

Higher surgeon volume reduces early failure in first time revision of non-infected total knee arthroplasty: An analysis using data from the United Kingdom National Joint Registry.

Alexander H Matthews, William K Gray, Jonathan P Evans, Jonathan T Evans, Sarah E Lamb, Andrew Porteous, Tim Briggs, Shiraz A Sabah, Abtin Alvand, Andrew D Toms and 1 more

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In one paragraph

Article 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 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–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

1 citing paper in PubMed.

  1. 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

11 authors.

Alexander H MatthewsGetting It Right First Time programme, NHS England, London, UK.ORCID http://orcid.org/0000-0002-1606-5840
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 College of Life and Environmental Sciences: University of Exeter Faculty of Health and Life Sciences.
Andrew PorteousNorth Bristol NHS Trust, Bristol, UK.
Tim BriggsGetting It Right First Time programme, NHS England, London, UK.
Shiraz A SabahNuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Abtin AlvandNuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Andrew D TomsRoyal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
Andrew J PriceNuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeRevision total knee replacement (RevKR) is an increasingly common procedure. It is hypothesised that higher surgical volume is linked to lower levels of adverse outcomes. The aim was to estimate the association of surgical volume on patient outcomes following first single-stage RevKR for non-infected indications.

methodsThis population-based cohort study used data from the United Kingdom National Joint Registry, Hospital Episode Statistics and National Patient Reported Outcome Measures. Patients undergoing procedures between 1 January 2009 and 30 June 2019 were included. The primary outcome measure was re-revision within 2 years; chosen to reflect the quality of the surgical provision. Fixed effect multivariable regression models were used to examine the association between surgeon and surgical unit annual caseload and the risk of adverse outcomes.

resultsA total of 8695 patients underwent first time single stage revision for aseptic loosening, instability, or malalignment across 389 surgical units and 1204 surgeons. Following adjustment for age, gender, ASA grade, year of surgery and operation funder, higher surgeon volume was associated with a lower risk of re-revision at 2 years. The risk of re-revision decreased amongst surgeons performing ≥9 annual revisions (OR 0.77, 95% CI 0.62-0.95, p-value = 0.02) compared to those performing <9 annual revisions.

conclusionsAnnual surgeon case volume of ≥9 first single-stage RevKR for non-infected indications is independently associated with reductions in early re-revision. This evidence supports the setting of minimum volume targets to improve outcomes for patients. LEVEL OF EVIDENCE: Level III, retrospective cohort study of prospectively collected data.

Indexed as

Arthroplasty, Replacement, KneeProsthesis FailureReoperationAgedAged, 80 and overFemaleHumansMaleMiddle AgedRegistriesRetrospective StudiesUnited Kingdommortality ratesre‐revision ratesrevision total knee replacementtotal knee arthroplastyvolume‐outcomes

Identifiers

PMID40351240
PMCPMC12392377

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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.