The influence of surgeon caseload and usage on the long-term outcomes of mobile-bearing Unicompartmental Knee Arthroplasty:  An analysis of data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man

Hasan R Mohammad; Andrew Judge; David Murray

doi:10.1016/j.arth.2022.08.011

The influence of surgeon caseload and usage on the long-term outcomes of mobile-bearing Unicompartmental Knee Arthroplasty: An analysis of data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man

Hasan R Mohammad^*
, Andrew Judge
, David Murray

^*Corresponding author for this work

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

24 Citations (Scopus)

165 Downloads (Pure)

Abstract

Background
Unicompartmental knee arthroplasty (UKA) revision rates are variable and known to be influenced by a surgeon’s caseload (number of UKAs performed annually) and usage (UKA as a proportion of overall knee arthroplasty practice). It is not known which is more important. We explored the influence of caseload and usage on cemented and cementless UKA.

Methods
A total of 34,277 medial Oxford UKAs (23,707 cemented and 10,570 cementless) from the National Joint Registry were analyzed. UKAs were subdivided by the following: (1) surgeon caseload, into low (
Results
The 10-year survival of the low-caseload/low-usage cemented and cementless UKA was 82.8% (CI 81.6-83.9) and 86.2% (CI 72.1-93.4), respectively. The 10-year survival of the high-caseload/high-usage cemented and cementless UKA was 90.0% (CI 89.2-90.6) and 93.3% (CI 91.3-94.8), respectively. For cemented UKA, the high-caseload/high-usage group had lower revision rates (hazard ratio [HR] 0.57, CI 0.52-0.63, P < .001) compared to the low-caseload/low-usage group. The high-caseload/low-usage (HR 0.74, CI 0.66-0.83, P < .001) and the low-caseload/high-usage (HR 0.86, CI 0.74-0.99, P = .04) groups also had lower revision rates than the low-caseload/low-usage group.

Conclusion
Mobile-bearing UKA revision rates improve with both increasing surgeon UKA caseload and usage. Surgeons using cemented UKA who have usage ≥20% and caseload ≥10/year had a 10-year survival of 90%. Higher survivorship was associated with higher caseload, higher usage, and cementless fixation.

Original language	English
Pages (from-to)	245-251
Number of pages	7
Journal	Journal of Arthroplasty
Volume	38
Issue number	2
Early online date	11 Aug 2022
DOIs	https://doi.org/10.1016/j.arth.2022.08.011
Publication status	E-pub ahead of print - 11 Aug 2022

Bibliographical note

Funding Information:
HRM was funded by the Henni Mester scholarship from the Univeristy of Oxford and the Royal College of Surgeons Research Fellowship. DWM reports a research grant from Zimmer Biomet to the University of Oxford.

Publisher Copyright:
© 2022 Elsevier Inc.

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Mohammad, H. R., Judge, A., & Murray, D. (2022). The influence of surgeon caseload and usage on the long-term outcomes of mobile-bearing Unicompartmental Knee Arthroplasty: An analysis of data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. Journal of Arthroplasty, 38(2), 245-251. Advance online publication. https://doi.org/10.1016/j.arth.2022.08.011

@article{0fa5e67f3c624fb2bae8c3a3ff49feef,

title = "The influence of surgeon caseload and usage on the long-term outcomes of mobile-bearing Unicompartmental Knee Arthroplasty: An analysis of data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man",

abstract = "Background Unicompartmental knee arthroplasty (UKA) revision rates are variable and known to be influenced by a surgeon{\textquoteright}s caseload (number of UKAs performed annually) and usage (UKA as a proportion of overall knee arthroplasty practice). It is not known which is more important. We explored the influence of caseload and usage on cemented and cementless UKA. Methods A total of 34,277 medial Oxford UKAs (23,707 cemented and 10,570 cementless) from the National Joint Registry were analyzed. UKAs were subdivided by the following: (1) surgeon caseload, into low ( Results The 10-year survival of the low-caseload/low-usage cemented and cementless UKA was 82.8\% (CI 81.6-83.9) and 86.2\% (CI 72.1-93.4), respectively. The 10-year survival of the high-caseload/high-usage cemented and cementless UKA was 90.0\% (CI 89.2-90.6) and 93.3\% (CI 91.3-94.8), respectively. For cemented UKA, the high-caseload/high-usage group had lower revision rates (hazard ratio [HR] 0.57, CI 0.52-0.63, P < .001) compared to the low-caseload/low-usage group. The high-caseload/low-usage (HR 0.74, CI 0.66-0.83, P < .001) and the low-caseload/high-usage (HR 0.86, CI 0.74-0.99, P = .04) groups also had lower revision rates than the low-caseload/low-usage group. Conclusion Mobile-bearing UKA revision rates improve with both increasing surgeon UKA caseload and usage. Surgeons using cemented UKA who have usage ≥20\% and caseload ≥10/year had a 10-year survival of 90\%. Higher survivorship was associated with higher caseload, higher usage, and cementless fixation.",

author = "Mohammad, \{Hasan R\} and Andrew Judge and David Murray",

note = "Funding Information: HRM was funded by the Henni Mester scholarship from the Univeristy of Oxford and the Royal College of Surgeons Research Fellowship. DWM reports a research grant from Zimmer Biomet to the University of Oxford. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2022",

month = aug,

day = "11",

doi = "10.1016/j.arth.2022.08.011",

language = "English",

volume = "38",

pages = "245--251",

journal = "Journal of Arthroplasty",

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Mohammad, HR, Judge, A & Murray, D 2022, 'The influence of surgeon caseload and usage on the long-term outcomes of mobile-bearing Unicompartmental Knee Arthroplasty: An analysis of data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man', Journal of Arthroplasty, vol. 38, no. 2, pp. 245-251. https://doi.org/10.1016/j.arth.2022.08.011

The influence of surgeon caseload and usage on the long-term outcomes of mobile-bearing Unicompartmental Knee Arthroplasty: An analysis of data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. / Mohammad, Hasan R; Judge, Andrew; Murray, David.
In: Journal of Arthroplasty, Vol. 38, No. 2, 11.08.2022, p. 245-251.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - The influence of surgeon caseload and usage on the long-term outcomes of mobile-bearing Unicompartmental Knee Arthroplasty

T2 - An analysis of data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man

AU - Mohammad, Hasan R

AU - Judge, Andrew

AU - Murray, David

N1 - Funding Information: HRM was funded by the Henni Mester scholarship from the Univeristy of Oxford and the Royal College of Surgeons Research Fellowship. DWM reports a research grant from Zimmer Biomet to the University of Oxford. Publisher Copyright: © 2022 Elsevier Inc.

PY - 2022/8/11

Y1 - 2022/8/11

N2 - Background Unicompartmental knee arthroplasty (UKA) revision rates are variable and known to be influenced by a surgeon’s caseload (number of UKAs performed annually) and usage (UKA as a proportion of overall knee arthroplasty practice). It is not known which is more important. We explored the influence of caseload and usage on cemented and cementless UKA. Methods A total of 34,277 medial Oxford UKAs (23,707 cemented and 10,570 cementless) from the National Joint Registry were analyzed. UKAs were subdivided by the following: (1) surgeon caseload, into low ( Results The 10-year survival of the low-caseload/low-usage cemented and cementless UKA was 82.8% (CI 81.6-83.9) and 86.2% (CI 72.1-93.4), respectively. The 10-year survival of the high-caseload/high-usage cemented and cementless UKA was 90.0% (CI 89.2-90.6) and 93.3% (CI 91.3-94.8), respectively. For cemented UKA, the high-caseload/high-usage group had lower revision rates (hazard ratio [HR] 0.57, CI 0.52-0.63, P < .001) compared to the low-caseload/low-usage group. The high-caseload/low-usage (HR 0.74, CI 0.66-0.83, P < .001) and the low-caseload/high-usage (HR 0.86, CI 0.74-0.99, P = .04) groups also had lower revision rates than the low-caseload/low-usage group. Conclusion Mobile-bearing UKA revision rates improve with both increasing surgeon UKA caseload and usage. Surgeons using cemented UKA who have usage ≥20% and caseload ≥10/year had a 10-year survival of 90%. Higher survivorship was associated with higher caseload, higher usage, and cementless fixation.

AB - Background Unicompartmental knee arthroplasty (UKA) revision rates are variable and known to be influenced by a surgeon’s caseload (number of UKAs performed annually) and usage (UKA as a proportion of overall knee arthroplasty practice). It is not known which is more important. We explored the influence of caseload and usage on cemented and cementless UKA. Methods A total of 34,277 medial Oxford UKAs (23,707 cemented and 10,570 cementless) from the National Joint Registry were analyzed. UKAs were subdivided by the following: (1) surgeon caseload, into low ( Results The 10-year survival of the low-caseload/low-usage cemented and cementless UKA was 82.8% (CI 81.6-83.9) and 86.2% (CI 72.1-93.4), respectively. The 10-year survival of the high-caseload/high-usage cemented and cementless UKA was 90.0% (CI 89.2-90.6) and 93.3% (CI 91.3-94.8), respectively. For cemented UKA, the high-caseload/high-usage group had lower revision rates (hazard ratio [HR] 0.57, CI 0.52-0.63, P < .001) compared to the low-caseload/low-usage group. The high-caseload/low-usage (HR 0.74, CI 0.66-0.83, P < .001) and the low-caseload/high-usage (HR 0.86, CI 0.74-0.99, P = .04) groups also had lower revision rates than the low-caseload/low-usage group. Conclusion Mobile-bearing UKA revision rates improve with both increasing surgeon UKA caseload and usage. Surgeons using cemented UKA who have usage ≥20% and caseload ≥10/year had a 10-year survival of 90%. Higher survivorship was associated with higher caseload, higher usage, and cementless fixation.

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DO - 10.1016/j.arth.2022.08.011

M3 - Article (Academic Journal)

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SN - 0883-5403

VL - 38

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EP - 251

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

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Mohammad HR, Judge A, Murray D. The influence of surgeon caseload and usage on the long-term outcomes of mobile-bearing Unicompartmental Knee Arthroplasty: An analysis of data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. Journal of Arthroplasty. 2022 Aug 11;38(2):245-251. Epub 2022 Aug 11. doi: 10.1016/j.arth.2022.08.011