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Background: The number of total knee replacements has substantially increased worldwide over the past ten years.Several studies have indicated a correlation between high hospital procedure volume and decreased morbidity andmortality following total knee arthroplasty. The purpose of the present study was to evaluate whether there is a correlationbetween procedure volume and the risk of revision following total knee arthroplasty with use of hospital volume data fromthe Norwegian Arthroplasty Register.Methods: Thirty-seven thousand, three hundred and eighty-one total knee arthroplasties that were reported to theNorwegian Arthroplasty Register from 1994 to 2010 were used to examine the annual procedure volume per hospital.Hospital volume was divided into five categories according to the number of procedures performed annually: one to twentyfour(low volume), twenty-five to forty-nine (medium volume), fifty to ninety-nine (medium volume), 100 to 149 (highvolume), and ‡150 (high volume). Cox regression (adjusted for age, sex, and diagnosis) was used to estimate the proportionof procedures without revision and the risk ratio (RR) of revision. Analyses were also performed for two commonly usedprosthesis brands combined.Results: The rate of prosthetic survival at ten years was 92.5% (95% confidence interval, 91.5 to 93.4) for hospitals withan annual volume of one to twenty-four procedures and 95.5% (95% confidence interval, 94.1 to 97.0) for hospitals with anannual volume of ‡150 procedures. We found a significantly lower risk of revision for hospitals with an annual volume of100 to 149 procedures (relative risk = 0.73 [95% confidence interval, 0.56 to 0.96], p = 0.03) and ‡150 procedures(relative risk = 0.73 [95% confidence interval, 0.54 to 1.00], p = 0.05) compared with hospitals with an annual volume ofone to twenty-four procedures. Similar results were found when we analyzed two commonly used prosthesis brands.Conclusions: In the present study, there was a significantly higher rate of revision knee arthroplasties at low-volumehospitals as compared with high-volume hospitals.</p

Influence of Hospital Volume on Revision Rate After Total Knee Arthroplasty with Cement