Most Military Arthroplasty Surgeons Have a Low Volume Practice in the Military Health System

The purpose of this study is to investigate hospital and surgeon joint arthroplasty volume in the Military Health System (MHS). A secondary aim is to look at interruption in physician practice during the study period.

Review of all patients undergoing hip or knee arthroplasty in the MHS over >5-year period to examine hospital and surgeon volume for total joint arthroplasty (TJA). We stratified hospital and surgeon volume into low, medium, and high volumes.

Fifty surgeons performed at least 50 hip and/or knee arthroplasties during this period. These surgeons accounted for 75% of TJA in the MHS. When stratified by cases per year, the median primary total hip arthroplasty (THA) per year was 31.4 and primary total knee arthroplasty (TKA) was 47.3 per year. Regarding the volume threshold for primary and revision TJA, all hospitals were classified as having low volumes for both THA and unicompartmental knee arthroplasty/TKA. There were 0 high volume, 7 (21.9%) medium volume, and 25 (78.1%) low volume THA surgeons; there was 1 high volume TKA surgeon, 17 (34.7%) medium volume, and 31 (63.3%) low volume TKA surgeons. The average duration of clinical activity for fellowship-trained surgeons over the study period was 4.0 years, and the average duration of clinical inactivity was 263.7 days (17.9% of practice period).

The highest-volume military arthroplasty surgeons have low volume when compared to their civilian colleagues. There are also long periods of clinical practice interruption. These findings stress the need to establish civilian-DOD or DOD-VA working relationships so that MHS patients experience the best possible care by high-volume surgeons in high-volume surgical centers.