Effects of increased surgical volume on total knee arthroplasty complications

The effect of increased total knee arthroplasty (TKA) surgical volume on the incidence of knee complications within a single surgeon's practice was determined. Data were collected prospectively on 600 primary TKAs. Major complications required knee reoperation. Minor complications were wound concerns requiring increased surveillance or oral antibiotics. Twelve major (2.0%) and 40 minor (6.7%) complications occurred at minimum 2-year follow-up. Surgical volume increased from 57 to 150 procedures per 6 months through the course of the study. Multivariate analysis determined that increased surgical volume was associated with lower rates of both major and minor complications, adjusted odds ratio 0.62 (95% confidence interval [CI], 0.40-0.96) and 0.56 (95% CI, 0.43-0.73), respectively. For each additional 50 procedures performed within a 6-month interval, major complications were reduced by 38% (P = .03), and minor complications were reduced by 44% (P < .0001). All complications were significantly decreased when the surgeon was performing 112 +/- 44 TKAs compared with 85 +/- 49 TKAs per 6-month interval.