Association of Technology Usage and Decreased Revision TKA Rates for Low-Volume Surgeons Using an Optimal Prosthesis Combination: An Analysis of 53,264 Primary TKAs.

Michael McAuliffe,Ibrahim Darwish,Jon Anderson,Alex Nicholls,Sophie Corfield,Dylan Harries,Christopher Vertullo
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Abstract

BACKGROUND Technology (navigation and robotics) usage during total knee arthroplasty (TKA) is often supported by literature involving high-volume surgeons and hospitals, but the value of technology for lower-volume surgeons is uncertain. This study aimed to determine if there was a relationship among surgeon volume, technology usage, and revision rate when using an optimal prosthesis combination (OPC). METHODS Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data were obtained from January 1, 2008, to December 31, 2022, for all primary TKA procedures performed for osteoarthritis using an OPC by a known surgeon ≥5 years after their first recorded procedure. The interaction between surgeon volume and conventional-instrumentation (CV) versus technology-assisted (TA) TKA was assessed. The cumulative percent revision (CPR) was determined by Kaplan-Meier estimates. Cox proportional-hazards methods were used to compare rates of revision by surgeon volume and by the interaction of volume and technology. Subanalyses were undertaken to examine major and minor revisions separately, and to assess the influence of technology on revision rates relative to those of a surgeon undertaking 100 TKA/year. RESULTS Of the 53,264 procedures that met the inclusion criteria, 31,536 were TA-TKA and 21,728 were CV-TKA. Use of technology reduced the all-cause revision rate for surgeons with a volume of <50 TKA/year and the rate of minor revisions for surgeons with a volume of <40 TKA/year. No interaction between surgeon volume and the rate of major revision surgery was found. With CV-TKA by a surgeon with a 100-TKA/year volume as the comparator, all-cause and major revision rates were significantly elevated for surgeons undertaking <50 and <100 TKA/year, respectively. In contrast, analysis of TA-TKA showed no difference in rates of all-cause or major revisions for surgeons undertaking <100 TKA/year compared with 100 TKA/year. CONCLUSIONS TA-TKA was associated with a decrease in the revision rate for lower-volume surgeons but no significant alterations in revision rate for higher-volume surgeons. Preferential use of TA-TKA by lower-volume surgeons should be considered. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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使用最佳假体组合的低手术量外科医生的技术使用与 TKA 翻修率降低的关系:对53,264例初次TKA的分析。
背景在全膝关节置换术(TKA)中使用技术(导航和机器人技术)通常得到高产量外科医生和医院文献的支持,但技术对低产量外科医生的价值还不确定。本研究旨在确定在使用最佳假体组合(OPC)时,外科医生的工作量、技术使用率和翻修率之间是否存在关系。方法从2008年1月1日到2022年12月31日,获得了澳大利亚矫形外科协会国家关节置换登记处(AOANJRR)的数据,这些数据是由已知的外科医生在首次记录手术后≥5年使用OPC为骨关节炎进行的所有初级TKA手术。评估了外科医生数量和传统器械(CV)与技术辅助(TA)TKA 之间的交互作用。通过 Kaplan-Meier 估计确定了累计翻修率 (CPR)。采用 Cox 比例危险度法比较不同外科医生手术量以及手术量与技术的交互作用所导致的翻修率。还进行了子分析,分别研究了大修率和小修率,并评估了相对于每年进行100例TKA的外科医生而言,技术对修补率的影响。结果 在符合纳入标准的53264例手术中,31536例为TA-TKA,21728例为CV-TKA。使用技术降低了年手术量小于50例TKA的外科医生的全因翻修率,降低了年手术量小于40例TKA的外科医生的轻微翻修率。外科医生的工作量与主要翻修手术率之间没有交互作用。以手术量为100 TKA/年的外科医生进行的CV-TKA为比较对象,手术量<50 TKA/年和<100 TKA/年的外科医生的全因翻修率和重大翻修率分别显著升高。与此相反,对TA-TKA的分析表明,承担<100 TKA/年的外科医生与承担100 TKA/年的外科医生相比,在全因和主要翻修率方面没有差异。结论STA-TKA与低手术量外科医生的翻修率下降有关,但与高手术量外科医生的翻修率没有明显变化有关。应考虑让工作量较少的外科医生优先使用TA-TKA。有关证据等级的完整描述,请参阅 "作者须知"。
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