Role of surgeon may affect revision rate after TKA more than choice of prosthesis
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Key takeaways:
- Superior prostheses had 1.9% and 7.9% revision rates among low and high revision rate surgeons, respectively.
- Middle prostheses had a 1.64 times higher rate of revision as superior prostheses beyond 2 years.
LAS VEGAS — Results presented here showed the role of the surgeon may have a greater effect on revision rates after total knee arthroplasty than the choice of the prosthesis.
“Future research should identify surgeon variables associated with lower revision rates and whether simply changing prostheses is enough to decrease your rate of revision,” Wayne Hoskins, PhD, FRACS, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Using data from the Australian Orthopaedic Association National Joint Replacement Registry, Hoskins and colleagues extracted the 2-year cumulative percent revision for all primary TKAs performed for osteoarthritis between 1999 and 2019 and used data to rank surgeon performance. Researchers also stratified surgeries by prosthesis performance independent of surgeon into superior-performing prostheses (lowest revision rates), identified prostheses (highest revision rates) and middle-performing prostheses (neither identified nor superior performing).
“Our primary outcome measure was a comparison of the revision rates and the different causes of revision when each group of surgeons used prostheses with different performances,” Hoskins said.
Revision rates
When superior-performing prostheses were used, Hoskins noted low revision rate surgeons had a 1.9% revision rate vs. 7.9% for high revision rate surgeons at 15 years. He added middle-performing prostheses had a revision rate of 2.6% for low revision surgeons and 8.3% for high revision surgeons at 10 years, while identified prostheses had a revision rate of 4.8% for low revision surgeons and 10.9% for high revision surgeons at 5 years.
“When solely looking at surgeries performed by low revision rate surgeons, identified prostheses had over double the risk of revision as middle prostheses and over triple the rate of superior prostheses,” Hoskins said.
Cause of revision
Although middle-performing prostheses had no differences in revision rates in the first 2 years compared with superior-performing prostheses, Hoskins noted middle-performing prostheses had a 1.64 times higher rate of revision beyond 2 years. Identified prostheses had double the rate of revision of both middle- and superior-performing prostheses when solely looking at surgeries performed by high revision rate surgeons, according to Hoskins. He added middle-performing prostheses had a 1.11 times higher rate of revision vs. superior-performing prostheses among high revision rate surgeons.
“When every surgeon used a superior prosthesis, infection was essentially the only known cause of revision for a low revision rate surgeon, whereas high revision rate surgeons had an increased rate of revision due to infection, as well as revision due to loosening and instability,” Hoskins said. “For middle-performing prostheses, similar results were found and for identified prostheses, loosening was the dominant mode of failure.”
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Hoskins W, et al. Paper 84. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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