Hip and knee replacement surgery is riskier in hospitals that carry out fewer operations, researchers have found. People are more likely to get blood clots or die at quieter hospitals, compared with hospitals that perform the operations regularly.

According to the American Academy of Orthopaedic Surgeons, around 800,000 hip and knee replacement surgeries are performed in the United States each year. A joint replacement can help people with severe arthritis move around more easily and have less pain, but it involves major surgery and things can sometimes go wrong.

In the study, which looked at the medical records of around 30,000 people, hospitals that performed more than 200 hip or knee replacements each year had better results. Patients treated in hospitals that performed fewer operations ran a higher risk of getting a blood clot or dying within a year of surgery.

In hospitals that performed 25 or fewer hip replacements a year, 4 in 100 people died within a year of their operation. In hospitals performing more than 200, the death rate was less than 1 in 100.

A knee replacement is a smaller operation, so the risk of complications is less. Around 2 in 100 people got at least one complication, such as a blood clot or an infection, but this didn’t vary according to how many operations the hospitals performed. However, when the researchers looked only at older patients, who are more vulnerable to complications, they found a higher risk of dying for patients treated in hospitals performing fewer knee replacements.

The study doesn’t tell us why hospitals do better if they perform more operations. It could be that these hospitals have better facilities, and the surgeons there gain more experience. These hospitals might also do a better job of caring for patients after surgery—for example, by recommending the right medication to prevent blood clots.

Bottom line. The study suggests that you should choose a hospital that treats lots of patients if you’re planning to have a hip or knee replacement. Painkillers and physical therapy are other treatment options for arthritis.

Before deciding on surgery, read our report on treatment options for arthritis.

Source
Hospital volume and surgical outcomes after elective hip/ knee arthroplasty: a risk adjusted analysis of a large regional database. [Arthritis & Rheumatism]

—Philip Wilson, patient editor, BMJ Group

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