High-volume surgeons linked with lower revision rates after patellofemoral arthroplasty
Key takeaways:
- High-volume surgeons may have improved patellofemoral arthroplasty outcomes vs. low-volume surgeons.
- High-volume surgeons were defined as performing more than five patellofemoral arthroplasties per year.
Published results showed high-volume surgeons who performed more than five patellofemoral arthroplasty procedures per year had decreased rates of revision compared with low-volume surgeons.
In addition, high-volume surgeons were associated with decreased rates of complications and an increased likelihood of diagnosing and operating on patients with patellar disorders compared with low-volume surgeons.
“In the absence of national guidelines for treating patellofemoral joint osteoarthritis, patients may be unaware of the potential surgical options available to them unless they are offered them,” Martinique Vella-Baldacchino, MD, MRCS (Eng), IOC Dip Sports Med, and colleagues from the Imperial College London wrote in the study. “This study offers guidance for those surgeons wishing to perform patellofemoral arthroplasty, suggesting a minimum caseload of five patellofemoral arthroplasties per year.”
Vella-Baldacchino and colleagues used National Joint Registry data to analyze 14,615 patellofemoral arthroplasty cases performed between January 2003 and December 2021. Among knee surgeons in the registry, 858 (28%) performed at least one patellofemoral arthroplasty during the study period. High-volume surgeons were defined as surgeons who performed at least five patellofemoral arthroplasties per year.
Vella-Baldacchino and colleagues found high-volume surgeons had an overall hazard ratio of 0.98 per additional case per year. They found high-volume surgeons had significantly decreased revision rates (HR = 0.92 per additional case per year; 95% CI, 0.86-0.99) and decreased complication rates (OR = 0.97 per additional case per year; 95% CI, 0.95-0.99) compared with low-volume surgeons. According to the study, the most common reason for revision was progressive OA.
In addition, high-volume surgeons were more likely to diagnose and operate on patients with patellar disorders, such as trochlear dysplasia and patellar dislocation (OR = 1.34; 95% CI, 1.09-1.77).
Vella-Baldacchino and colleagues noted inlay implants were associated with an increased risk of revision for both high-volume surgeons (HR = 2.38; 95% CI, 1.83-3.11) and low-volume surgeons (HR = 1.68; 95% CI, 1.23-2.30).
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