Table 1

A literature review of publications in English from 2011 to 2021, with a minimum of 20 000 patients included, evaluating the effect of surgeon and/or hospital volume on total knee replacement outcome

Surgeon–volume relationship
StudyNSettingVolume thresholdsDefinition of thresholdOutcomeResultOR (95 % CI)
P value
Author yearNo of TKRsData source, countryLowMedium lowMedium highHighVery High(Method)TypeLow versus high volume
Namba etal12 2013a64 017Total Joint Replacement Registry, USA1–910–49≥50Not explainedAseptic revisionNo difference1.11
(0.66 to1.12)
0.690
Namba13
2013b
56 216Total Joint Replacement Registry, USA<2020–49≥50Not explainedSurgical site infectionNo difference1.30
(0.90 to 1.88)
0.160
Wilson2
2016
289 976Statewide Planning and Research Cooperative System (SPARCS), New York, USA0–1213–5960–145≥146SSLRCR and revisionHigher risk for low volume1.85
(1.75 to 1.97)
NR
Yu8
2019
30 828Taiwan National Health Insurance Research Data base, Taiwan1–49≥50RCSRReadmissionHigher risk for low volume1.44
(1.22 to 1.69)
<0.001
Hospital–volume relationship
de la Torre etal14
2019
36 316Catalan Arthroplasty Registry, Spain<125>125Previous studiesRevisionHigher risk for low volume1.29
(1.16 to 1.44)
NR
Badawy etal7
2013
26 698Norwegian Arthroplasty Register, Norway<2525–4950–99100–149≥150Previous studiesRevisionNo difference0.81*
0.68
D’apuzzo etal15
2017
377 705Statewide Planning and Research Cooperative System (SPARCS), New York, USA1–8990–235236–644≥645SSLRReadmissionHigher risk for low volume1.32
(1.16 to 1.51) <0.001
Kurtz6
2016
952 593Medicare 100% claims, USA150–299300–499450–599≥600Not explainedReadmissionHigher readmissions for low volume51.2%†
Meyer etal16
2011
43 180Krankenhaus- Infektions-Surveillance System, Germany1–5051–99>100Previous studiesSurgical site infectionsHigher risk for low volume2.04
NR
Namba et al12
2013a
64 017Total Joint Replacement Registry, USA<100100–199≥200Not explainedAseptic revisionNo difference0.93
(0.59 to 1.48)
0.769
Namba13
2013b
56 216Total Joint Replacement Registry, USA<100100–199≥200Not explainedSurgical site infectionlower risk for low volume0.33
(0.12 to 0.90)
0.030
Pamilo et al17
2015
59 696Perfect Knee Replacement database, Finland1–99100–249250–449>450chosen arbitrarilyLOS, Readmission, MUA, revisionHigher readmission risk for low volume, no difference for revisionReadmission:
1.11
(1.03 to 1.19)
NR
Revision:
1.08
(0.93 to 1.26)
NR
Singh et al18
2011
19 418Pennsylvania Healthcare Cost Containment Council database, USA1–2526–100101–200>200Not explainedCR and MRHigher risk for low volumeCR:
1.1
(0.8 to 1.6)
NR
MR:
1.0 (0.4 to 2.6)
NR
Wilson2
2016
289 976Statewide Planning and Research Cooperative System (SPARCS), New York, USA0–8990–235236–644>645SSLRCR and revisionHigher risk for low volume1.37
(1.32 to 1.42)
NR
Yu8
2019
30 828Taiwan National Health Insurance Research Data base, Taiwan1–74>75RCSRReadmissionNo association1.07
(0.90 to 1.28)
0.435
  • Search performed in Medline 9 April 2021 yielded 72 papers for screening.

  • *Relative risk,.

  • †Percentage difference.

  • CR, complication rate; LOS, length of stay; MR, mortality rate; MUA, manipulation under anaesthesia; NR, not reported; RCSR, Restricted Cubic Spline Regression; SSLR, Stratum-specific likelihood ratio.