Outcome of hip resurfacing may be dependent on experience

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By Gina Brockenbrough
February 27, 2009

LAS VEGAS — A new study links outcomes of hip resurfacing to the hospital volume
of resurfacing cases and, thereby, the surgeon’s experience.

To evaluate the impact of operative volume on hip resurfacing outcomes, Andrew
J. Shimmin, MBBS, FAOrthA, and colleagues used the Australian Joint Registry to
identify nearly 9,000 hip resurfacings performed at 196 hospitals between
September 1999 and December 2006…

..They found that 74% of hospitals performed fewer than 30 procedures during the
7-year study period, while 64% of hip resurfacings were performed at 16
“high-volume” hospitals, or those that performed more than 100 cases. Overall,
the researchers found that 3.1% of resurfacings were revised…

…They then compared the cumulative rate of revision at 4 years among the
hospital groups. At 4 years, the investigators discovered a 6% revision rate for
centers performing fewer than 25 cases, a 5.6% rate for those performing 25-49
cases, a 4.7% rate for hospitals doing 50-99 cases, and a 2.7% revision rate for
those performing more than 100 cases.

After adjusting for patient age and gender, the investigators discovered that
the risk for revision was 66% greater in hospitals performing the least amount
of cases.

“In this study, hospital volume is primarily a reflection of the operative
experience of the individual surgeons,” Shimmin said at the American Academy of
Orthopaedic Surgeons 76th Annual Meeting, here.

“The outcome of hip resurfacing is strongly dependent on the experience of the
surgeon and hospital performing the procedure. Even when adjusted for patients’
age and sex, the risk of revision at low-volume centers was 66% greater than at
a higher volume center. This supports the need for increased training of
surgeons before undertaking hip resurfacing,” he said.

Reference:

Shimmin AJ. The effect of operative volume on the outcome of hip resurfacing.
Paper #316. Presented at the American Academy of Orthopaedic Surgeons 76th
Annual Meeting. Feb. 25-28, 2009. Las Vegas.