Abstract
Background
Both surgeon and hospital volume influence patient outcomes following revision knee arthroplasty.
Purpose
To audit all centres performing revision knee procedures in England and Wales over a 2-year period. All centres were audited against two pre-defined standards linked to hospital volume
Operative volume should be greater than 10 revisions per year;
More than 2.5 revisions should be performed for every 100 primary arthroplasties implanted.
Methods
Data for 9659 knee revisions performed in 359 different centres between 01/07/08 and 30/06/10 was accessed from the National Joint Registry for England and Wales. For each centre information on the volume of primary and revision knee procedures undertaken during this period was available and was used as the basis for audit.
Results
During the 2-year study period 396 different centres performed 153133 primary knee arthroplasties. Of these 359 (91%) performed 9659 knee revisions, equivalent to 6.2 revisions for every 100 primary arthroplasties performed. Revision centres included 208 (58%) NHS hospitals performing 8148 revisions, 141 (39%) independent hospitals performing 1258 revisions and 10 (3%) Independent Sector Treatment Centres (ISTC) performing 253 revisions.
The median number of revisions performed per hospital was 7 per year (Range 1 to 144). Volume differed dependent upon hospital type (NHS=14/year vs. Independent=3/year, p< 0.001). Two hundred and twelve (59%) centres performed < 10 revisions per year and thus fell below the audit standard. Eighty of these centres also performed < 2.5 revisions per 100 primaries. Of the 141 independent hospitals 128 (91%) fell below the suggested standards for revision volume.
Conclusions
A significant number of institutions are performing only a small volume of knee revision procedures. To ensure safe and sustainable practice with better outcomes, consideration should be given to rationalising the revision service in fewer centres.
