Search

STUDY QUESTION What are the rates of serious cardiovascular events in those who undergo primary total joint arthroplasty (TJA) compared with those who do not within three years of initial assessment? SUMMARY ANSWER Undergoing elective primary TJA within three years of initial assessment was associated with a significant 12.4% absolute reduction in subsequent risk of serious cardiovascular events. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Osteoarthritis is associated with increased mortality, particularly secondary to cardiovascular disease, with the risk for mortality proportional to the degree of disability secondary to the arthritis. This study suggests that management of hip or knee osteoarthritis with arthroplasty decreases the risk for subsequent serious cardiovascular events. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Is there a cut point in annual surgeon volume associated with increased risk for complications after primary elective total hip arthroplasty, and, if so, can we quantify this risk? SUMMARY ANSWER In a cohort of first time recipients of total hip arthroplasty, we found that patients operated on by surgeons who had performed 35 or fewer procedures in the year before the index arthroplasty were at increased risk for dislocation and early revision. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Though there is a general consensus that increased surgeon volume is associated with a reduced risk of complications, there is a lack of consensus around what constitutes a “low” annual volume. This study showed that in patients undergoing total hip arthroplasty, the risks for dislocation and early revision increased by about 48% and 44%, respectively, when they were operated on by surgeons with annual volumes ≤35 procedures. [ABSTRACT FROM AUTHOR]

The article discusses research which examined the rates of cardiovascular events in those who undergo primary total joint arthroplasty (TJA). Topics discussed include the association of osteoarthritis with increased mortality and utilisation of baseline questionnaire data from the Ontario Hip/Knee Study and use of a propensity score matched landmark analysis. Findings revealed a lower chance of cardiovascular events in the TJA group.

Competing Interests: Competing interests: None declared.

Objectives: This study aimed to identify a threshold in annual surgeon volume associated with increased risk of revision (for any cause) and deep infection requiring surgery following primary elective total knee arthroplasty (TKA)., Design: A propensity score matched cohort study., Setting: Ontario, Canada., Participants: 169 713 persons who received a primary TKA between 2002 and 2016, with 3-year postoperative follow-up., Main Outcome Measures: Revision arthroplasty (for any cause), and the occurrence of deep surgical infection requiring surgery., Results: Based on restricted cubic spline analysis, the threshold for increased probability of revision and deep infection requiring surgery was <70 cases/year. After matching of 51 658 TKA recipients from surgeons performing <70 cases/year to TKA recipients from surgeons with greater than 70 cases/year, patients in the former group had a higher rate of revision (for any cause, 2.23% (95% Confidence Interval (CI) 1.39 to 3.07) vs 1.70% (95% CI 0.85 to 2.55); Hazard Ratio (HR) 1.33, 95% CI 1.21 to 1.47, p<0.0001) and deep infection requiring surgery (1.29% (95% CI 0.44 to 2.14) vs 1.09% (95% CI 0.24 to 1.94); HR 1.33, 95% CI 1.17 to 1.51, p<0.0001)., Conclusions: For primary TKA recipients, cases performed by surgeons who had performed fewer than 70 TKAs in the year prior to the index TKA were at 31% increased relative risk of revision (for any cause), and 18% increased relative risk for deep surgical infection requiring surgery, at 3-year follow-up., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)