2025 ISAKOS Biennial Congress ePoster
Increased Patient Travel Distance for Revision Total Knee Arthroplasty is Associated With a Higher Re-revision Rate
Logan Finger, MD, Aliquippa, PA UNITED STATES
Yunseo Linda Park, BS, Pittsburgh, PA UNITED STATES
Matthew Como, BS, Allison Park, PA UNITED STATES
Akeem Williams, BS UNITED STATES
Kenneth Urish, MD, PhD
Michael O'Malley, MD, Pittsburgh, PA UNITED STATES
Brian Klatt, MD, Pittsburgh, PA UNITED STATES
Johannes F. Plate, MD, PhD, Pittsburgh, PA UNITED STATES
University of Pittsburgh, pittsburgh, PA, UNITED STATES
FDA Status Not Applicable
Summary
While controlling for a number of demographic factors, Increased travel distance for TKA revisions was found to be associated with higher rates of subsequent re-revision.
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Abstract
Introduction
The implementation of regional “Centers of Excellence” (COEs) for total joint arthroplasty (TJA) revisions has been contemplated in the authors’ large health system as well as nationwide. These tertiary facilities with fellowship trained arthroplasty surgeons and high yearly volume of TJA revisions may provide improved surgical and patient-reported outcomes (PROs). The purpose of this study was to analyze the influence of travel distance to these COEs on clinical outcomes and PROs following revision TKA.
Methods
All patients undergoing TKA revisions between 2015 and 2024 within a large regional health system were retrospectively reviewed using a custom data and analytics platform for TJA. The Vincenty formula was used to calculate the geographic distance between patients’ home zip codes and the coordinates of the hospitals at which they underwent revision surgery. Patients were divided into 3 groups based on their distance traveled (<25 miles, 25-74 miles, and >75 miles). Preoperative and postoperative PROs including, Knee injury and Osteoarthritis Outcome Score (KOOS), and Patient-Reported Outcomes Measurement Information System (PROMIS10) scores at 3-month, 6-month, and 1-year follow-up as well as complication rates were assessed.
Results
3168 patients were included in the final analysis. Of these, 2129 patients (67.2%) traveled <25 miles to their surgery hospital site with a mean distance of 8.1 ? 7.9 miles. 824 (26.0%) traveled 25-74 miles with a mean distance of 44.4 ? 14.4 miles. 215 (7%) traveled greater than 75 miles with a mean distance of 111.3 ± 105.7. Age (67.1 ± 10.0 in the <25 mile group, 66.7 ± 9.7 in the 25-74 mile group, 65.8 ± 10.3 in the >75 mile group, p=0.23) and BMI (33.4 ± 9.5 in the <25 mile group, 34.5 ± 17.4 in the 25-74 mile group, 32.7 ± 6.6 in the >75 mile group, p=0.41) were similar between groups while sex differed (59% female in the <25 mile group, 53% in the 25-74 mile group, 52% in the >75 mile group, p<0.01). Elixhauser scores were also different with the highest score of 2.99 ± 1.9 in the <25 mile group, 2.8 ± 1.9 in the 25-74 mile group, and 2.5 ± 1.8 in the >75 mile group (p<0.01). Rates of requiring a subsequent re-revision significantly differed between groups (13% vs 14% vs 19%, p=0.04), with the >75 mile group requiring most re-revisions. All other PROs and complication rates (p>0.05), 1-year mortality (p=0.28), 7-day readmit (p=0.10), 30-day readmit (p=0.59), 90-day readmit (p=0.84), were similar among the three groups.
Discussion And Conclusion
Increased travel distance for TKA revisions was associated with higher rates of subsequent re-revision. While further investigation into surgical complexities for these revision procedures is needed, these results provide insight for patients who are travelling further distances for revision TJA.