Fewer Problems after Total Knee Replacement with High-Volume DoctorsIt makes sense that the more often you do something, the better you get at it. This is also true for doctors who perform operations to replace knee joints. With this in mind, Medicare is even starting to regionalize total hip and knee replacements. This means all joint replacements would be done at select centers around the United States.
The results of this study may support this decision. Researchers at half a dozen major medical centers looked at Medicare claims for patients who had a total knee replacement (TKR). They found that patients had better results when managed by doctors who do a high volume of TKRs. Their patients had fewer problems after the operation.
All patients in the study were over 65 years of age. They were in good health and only had one knee replaced at the time of the study. Everyone was followed for at least 90 days. Five specific problems were tracked: death, heart attack, infection, pneumonia, and blood clot to the lungs. They also looked at the type of hospital (urban or rural) and how many years the doctor had been practicing.
The authors found that the death rate is 30 percent lower in hospitals where TKRs are done routinely. The risk of heart attack and lung clots was also lower in these high volume hospitals. Complications for any medical problem were lower in high-volume hospitals. Results showed that number of years in practice were not as important as the number of TKRs done each year.
The authors conclude that patients should be told about treatment options. High-volume centers may be a good idea, but more research is needed. Long-term results must be studied before advising that all TKRs should be done at high volume centers.
Jeffrey N. Katz, MD, MS, et al. Association Between Hospital and Surgeon Procedure Volume and the Outcomes of Total Knee Replacement. In The Journal of Bone and Joint Surgery. September 2004. Vol. 86-A. No. 9. Pp.1909-1916.
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