2025 ISAKOS Biennial Congress ePoster
Association Between Surgeon Volume And Patient Outcomes After Elective Patellofemoral Joint Replacement Surgery Using Data From The National Joint Registry And Hospital Episode Statistics For England: Population Based Cohort Study
Martinique Vella-Baldacchino, MD, MRCS, PG CERT (HEALTH LEADERSHIP), IOC DIp Spo, London, United Kingdom UNITED KINGDOM
Alex Bottle, Phd, London UNITED KINGDOM
Justin Cobb, MCh FRCS, London UNITED KINGDOM
Alex D Liddle, MBBS BSc DPhil FRCS(Orth), London UNITED KINGDOM
MSk Lab, Imperial College London, London, UNITED KINGDOM
FDA Status Cleared
Summary
Surgeons should be performing at least more than 5 cases of patellofemoral joint replacements per year to optimise patient outcomes
ePosters will be available shortly before Congress
Abstract
Background
Patellofemoral arthroplasty has been described as a technically demanding procedure. The objective was to determine the relationship between surgical experience and outcomes in the treatment of patellofemoral joint osteoarthritis.
Method
All patellofemoral joint arthroplasty (PFR) records in the national joint registry from 2003 to December 2021 were linked to the hospital episode statistics database, which consists of all patient records at each hospital admission in England. The yearly caseload and the prosthesis time incidence rate were calculated for each surgeon. A locally weighted scatterplot smoothing was plotted to determine any relationships between revision and caseload. Flexible parametric survival models were used to derive hazard ratios. Patient selection criteria for both high and low volume groups were compared. Multilevel logistic regression was used to compare serious adverse effects and complications differences between different surgeon groups. Differences in the type of implants used by surgeons were analysed. Associations between early versus late revision, based on surgeon volume groups and implant types, were explored. A case volume curve was plotted to predict the risk of failure in both groups. The reasons for revision in were explored.
Results
858 surgeons (26%) performed a PFR during the study period. 14,615 patellofemoral arthroplasty records were available for analysis. The modal yearly caseload was 2 per year. Higher volume surgeons were defined as surgeons performing more than 5 per year. The hazard ratio for a high volume surgeon was 0.98 and had a lower risk of revision irrespective of the patient’s age. Higher volume surgeons were 25% (0.23–0.25, p < 0.05) more likely to operate on healthier patients (ASA–1) and are more likely to operate on patients with patella disorders (OR 1.34, CI: 1.09 – 1.77, p<0.05) when compared with low volume surgeons. Patients operated on by higher volume surgeons were less likely to have a serious adverse effect (OR 0.97, CI: 0.95–0.99, P <0.05,).
Conclusion
This is the first study to examine the volume–outcome relationship in patellofemoral arthroplasty surgery and to explore differences in the selection of patients between high–volume arthroplasty and low–volume arthroplasty surgeons.