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Revision Rates After Total Knee Arthroplasty Among Surgeons of Varying Experience: An Australian Orthopaedic
Ameya Bhanushali1, Carl Holder2, Michael J McAuliffe2
1Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
Background:
Outcomes after total knee arthroplasty performed by consultant orthopaedic surgeons of varying experience have not been reported on within the Australian Orthopaedic Association National Joint Replacement Registry. Therefore, this study aimed to compare revision rates after total knee arthroplasty among early-career, mid-career, and end-of-career surgeons.
Methods:
Data were obtained retrospectively from the Australian Orthopaedic Association National Joint Replacement Registry for total knee arthroplasty performed by early-career, mid-career, and end-of-career surgeons between September 1999 and January 2023. Cumulative revision rates were compared between early-career, mid-career, and end-of-career surgeons. Indications for revision and the type of revision required were also compared between groups. A total of 50,291 total knee arthroplasties were assessed. Patients were aged 68 years and had 7.8 years of follow-up on average. In total, 12,402 patients were treated by early-career surgeons, 15,997 patients were treated by mid-career surgeons, and 21,892 patients were treated by end-of-career surgeons.
Results:
Overall revision rates and cumulative percentage revision rates at various time points were lowest in the mid-career surgeon cohort (5.1 versus 5.6 and 8% overall [P < 0.001]; 3.4 versus 4.3 and 4.4% at 5 years; 5.2 versus 6.2 and 6.5% at 10 years). Overall and cumulative percentage revision rates were not significantly different between end-of-career surgeons and early-career surgeons. Total knee arthroplasties performed by mid-career surgeons least commonly required revision for aseptic loosening, whereas those performed by early-career surgeons most commonly required revision of all components. Mid-career surgeons were the highest-volume surgeons, followed by end-of-career and then early-career surgeons.
Conclusions:
Total knee arthroplasties performed by mid-career surgeons are at lower risk of revision. This may be because they are higher volume surgeons or due to factors not captured in registry data. Where revision is required, less extensive revision is commonly required after total knee arthroplasty performed by mid-career surgeons.
