Association of surgeon factors with outcome scores after total knee arthroplasty

Purpose: To identify preoperative factors (including surgeon factors) associated with outcome scores after total knee arthroplasty (TKA).

Methods: Medical records of 2848 patients (3458 knees) who underwent primary TKA by 27 orthopaedic specialists were retrieved. Three specialty knee surgeons who had one-year fellowship in TKA performed 1930 TKAs, and 24 general orthopaedic surgeons performed 1528 TKAs. Four of them (including all 3 specialty knee surgeons) were ultrahigh- volume (≥ 100 TKAs a year), and 21 of them were senior consultants (≥ 5 years post residency). At 2 years, 2922 (85%) of knees had complete followup data. Oxford Knee Score, Knee Society knee and function scores, and SF-36 quality-of-life score were assessed by independent physiotherapists before and after surgery. Outcomes were compared in terms of dichotomised specialty, seniority, and surgical volume of surgeons.

Results: Comparing ultra-high-volume (≥ 100 TKAs per year) specialty knee surgeons with general orthopaedic surgeons, the former achieved better outcomes in terms of the Oxford Knee Score at 6 months, Knee Society knee and function scores at 2 years, and SF-36 scores at 6 months and 2 years. Comparing lower-volume (<100 TKAs per year) specialty knee surgeons with general orthopaedic surgeons, the former still achieved better outcome and quality-of-life scores, except for SF-36 Mental Component Score at 2 years.

Conclusion: Specialty training and clinical research in TKA improved outcome and quality-of-life scores.