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The impact of a revision arthroplasty network on patient outcomes

analysis of a national administrative data set in England

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Revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) are complex procedures with higher rates of re-revision, complications, and mortality compared to primary TKA and THA. We report the effects of the establishment of a revision arthroplasty network (the East Midlands Specialist Orthopaedic Network; EMSON) on outcomes of rTKA and rTHA.


The revision arthroplasty network was established in January 2015 and covered five hospitals in the Nottinghamshire and Lincolnshire areas of the East Midlands of England. This comprises a collaborative weekly multidisciplinary meeting where upcoming rTKA and rTHA procedures are discussed, and a plan agreed. Using the Hospital Episode Statistics database, revision procedures carried out between April 2011 and March 2018 (allowing two-year follow-up) from the five network hospitals were compared to all other hospitals in England. Age, sex, and mean Hospital Frailty Risk scores were used as covariates. The primary outcome was re-revision surgery within one year of the index revision. Secondary outcomes were re-revision surgery within two years, any complication within one and two years, and median length of hospital stay.


A total of 57,621 rTHA and 33,828 rTKA procedures were performed across England, of which 1,485 (2.6%) and 1,028 (3.0%), respectively, were conducted within the network. Re-revision rates within one year for rTHA were 7.3% and 6.0%, and for rTKA were 11.6% and 7.4% pre- and postintervention, respectively, within the network. This compares to a pre-to-post change from 7.4% to 6.8% for rTHA and from 11.7% to 9.7% for rTKA for the rest of England. In comparative interrupted time-series analysis for rTKA there was a significant immediate improvement in one-year re-revision rates for the revision network compared to the rest of England (p = 0.024), but no significant change for rTHA (p = 0.504). For the secondary outcomes studied, there was a significant improvement in trend for one- and two-year complication rates for rTHA for the revision network compared to the rest of England.


Re-revision rates for rTKA and complication rates for rTHA improved significantly at one and two years with the introduction of a revision arthroplasty network, when compared to the rest of England. Most of the outcomes studied improved to a greater extent in the network hospitals compared to the rest of England when comparing the pre- and postintervention periods.

Cite this article: Bone Joint J 2023;105-B(6):641–648.

Correspondence should be sent to Benjamin V. Bloch. E-mail:

P. J. James and A. R. J. Manktelow are joint senior authors.

The East Midlands Specialist Orthopaedic Network:

United Lincolnshire Hospitals NHS Trust

Prasad Antapur, Consultant Orthopaedic Surgeon

Mark Rowsell, Consultant Orthopaedic Surgeon

Hasnat Minhas, Consultant Orthopaedic Surgeon

Ahmed Othman, Consultant Orthopaedic Surgeon

Rohit Rambani, Consultant Orthopaedic Surgeon

Sherwood Forest Hospitals NHS Foundation Trust

Vikram Desai, Consultant Orthopaedic Surgeon

Bala Srinivasan, Consultant Orthopaedic Surgeon

Sushrut Kulkarni, Consultant Orthopaedic Surgeon

Abi Aladdin, Consultant Orthopaedic Surgeon

Practice Plus Hospital Balborough

Gyorgy Lovasz, Consultant Orthopaedic Surgeon

Nottingham University Hospitals NHS Trust

Anthony Westbrook, Consultant Orthopaedic Surgeon

Mark Hatton, Consultant Orthopaedic Surgeon

Mark Higgins, Consultant Orthopaedic Surgeon

Alan Broodryk, Consultant Orthopaedic Surgeon

Khosrow Sehat, Consultant Orthopaedic Surgeon

Nitin Badhe, Consultant Orthopaedic Surgeon

Ben Ollivere, Consultant Orthopaedic Surgeon

Will Manning, Consultant Orthopaedic Surgeon

Susan Snape, Consultant Infectious Diseases Physician

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