Rate of complications with hip and knee arthroplasties performed at a private hospital in Canada.

Abstract

Background: Canada's publicly funded health care systems offer limited scope for private delivery of medically necessary surgery, but in Quebec, private hospitals are permitted to perform hip and knee arthroplasty. Given the paucity of outcome data from Canadian private facilities performing joint replacements, we sought to provide evidence on complications to inform the ongoing discussion about the role of private hospitals in Canada's surgical landscape.

Methods: We prospectively collected complications and adverse events for all primary hip and knee arthroplasties performed at the Duval Clinic, a private hip and knee arthroplasty hospital, between January 2022 and December 2024. All patients were managed under an Enhanced Recovery After Surgery pathway. We classified complications as medical or orthopedic and analyzed these by type of procedure, year of occurrence, and need for hospitalization or reoperation.

Results: During the study period, 3111 patients received 3379 arthroplasties (2843 unilateral and 268 bilateral). We observed a total of 190 (5.62%) medical and orthopedic adverse events or complications. Twenty-one patients (0.68%) required transfer to a public hospital after surgery for further management of a postoperative complication. Thirty-two (1.03%) patients visited an emergency department after surgery for an unexpected problem. Twenty-five (0.74%) patients underwent reoperation for an orthopedic complication, 7 of which were performed at the private hospital.

Conclusion: Arthroplasty performed in a high-volume, accredited, private hip and knee arthroplasty hospital can achieve low complication rates. Transparent reporting of surgical safety in both public and private facilities is essential to guide patient choice and health policy.