In an article published in the January 2016 issue of the Journal of Bone and Joint Surgery, authors Liddle et al. reviewed the effects of surgical volume on outcomes for knee replacement. They reviewed 459,280 patient records from the National Joint Registry for England and Wales and found that the number of cases affected survival of both total knee replacement and, more strongly, unicompartmental knee replacement. They noted that the revision rate for unicompartmental or partial knee replacement dropped steeply, up to 10 cases per year, after which the rate of revision tended to plateau at 30 cases per year. The surgeons performing fewer than 10 partial knee replacements per year had an 8-year survival rate of 88%, compared to 92% for joint replacement surgeons who performed 30 partial knee replacements per year.
They concluded that surgical case volume is an important factor in determining survival of partial knee replacement and, to a lesser extent, total knee replacement; surgeons who are unable to achieve a sufficient caseload for a partial knee replacement should abandon the procedure and refer suitable patients to surgeons performing a higher volume. In the study, the authors confirmed the importance of surgical caseload in determining survival of knee replacement. There are many variables involved in this phenomenon, but patient selection and revision threshold of lower-volume surgeons may be a factor in differences in survivorship.