The effect of minimum volume recommendations on surgeon activity for first revision total knee replacement: an analysis of 2009–2019 United Kingdom National Joint Registry data

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2025-05-29 DOI:10.1016/j.knee.2025.05.015

Alexander H. Matthews , William K. Gray , Jonathan P. Evans , Jonathan T. Evans , Tim Briggs , Shiraz A. Sabah , Andrew Price , Andrew D. Toms

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引用次数: 0

Abstract

Aims

The aim of this study was to investigate changes in first time revision knee replacement (RevKR) volumes following the publication of a report identifying low surgeon volumes in England. As a secondary aim we sought to investigate the rate of accrual of volumes for early career surgeons.

Methods

This population-based cohort study used data from the United Kingdom National Joint Registry. Patients undergoing first time RevKR between 1st January 2009 and 31 December 2019. Annual revision volumes for each surgeon were calculated and trends in surgeon volumes plotted as medians and bootstrapped 95% confidence intervals. Data before and after the report was compared. The rate of accrual of experience for new surgeons inclusive of both first-time revisions and re-revisions was calculated and adjusted for unit volume.

Results

A total of 21,067 patients were included. Over the whole study period, 123/1433 (8.58%) of surgeons achieved a mean annual volume of 15 or more revisions. Temporal trends in surgeon revision volumes observed an increase for non-acute indications. New surgeons in lower volume units have 42% lower chance of reaching 15 operations per year compared to those in the highest volume units (HR 0.52; 95% CI 0.33 to 0.83).

Conclusions

We observed an increase in surgeon volumes following the report in first time non acute RevKRs. New RevKR surgeons were more likely to achieve and maintain revision volume targets in higher volume centres, this supports the drive for dual consultant operating and prospective revision knee consultants being appointed to highest volume units.

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最小容量建议对首次翻修全膝关节置换术的外科医生活动的影响：2009-2019年英国国家联合登记数据分析

本研究的目的是调查在英国发表了一份确定低外科手术量的报告后，首次翻修膝关节置换术（RevKR）量的变化。作为次要目的，我们试图调查早期职业外科医生的容积增加率。方法：这项基于人群的队列研究使用了来自英国国家联合登记处的数据。2009年1月1日至2019年12月31日期间首次接受RevKR治疗的患者。计算每位外科医生的年度翻修量，并绘制外科医生数量的趋势为中位数和自举95%置信区间。对比报告前后的数据。计算新外科医生的经验累积率，包括第一次翻修和再翻修，并根据单位体积进行调整。结果共纳入21067例患者。在整个研究期间，123/1433（8.58%）的外科医生实现了平均每年15次或以上的手术量。非急性指征的外科手术翻修量的时间趋势有所增加。与大容量单位相比，小容量单位的新外科医生每年完成15例手术的机会低42% (HR 0.52；95% CI 0.33 ~ 0.83)。结论：我们观察到，在首次非急性RevKRs报告后，外科医生数量增加。新的RevKR外科医生更有可能在更高容量的中心实现和维持翻修量目标，这支持了双顾问手术和前瞻性翻修膝关节顾问被任命到最高容量单位的动力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.