Total hip arthroplasty and Total Knee Arthroplasty Survivorship in the United States Medicare Population: Effect of Hospital and Surgeon Procedure Volume

Our study examined the association between hospital and surgeon volume with primary total hip arthroplasty and total knee arthroplasty survivorship at 0.5 to 8 years in the Medicare population between 1997 and 2004. Kaplan-Meier method and Cox regression were used to determine implant survivorship and hazard ratios associated with hospital and surgeon procedure volume at 0.5, 2, 5, and 8 years. Total hip arthroplasty patients of the highest-volume surgeons (>50) had a higher implant survival rate at 6 months than those of surgeons with volumes of 6 to 10 and 11 to 25 (adjusted odds ratio of 1.69 and 1.64, respectively). Total knee arthroplasty patients in lowest-volume hospitals (1-25) had a higher risk of revision at 5 and 8 years compared with those operated on in highest-volume hospitals (>200) (adjusted odds ratio, 1.57 and 1.52, respectively). Remaining volume effects were not significant. Longer-term follow-up will be required to determine if these relationships, or lack thereof, persist.