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Fewer Problems after Total Knee Replacement
with High-Volume Doctors
Posted November 16th, 2004 by Matt
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It makes sense that the more often you do something, the
better you get at it. This is also true for doctors who perform operations to
replace knee joints. With this in mind, Medicare is even starting to regionalize
total hip and knee replacements. This means all joint replacements would be done
at select centers around the United States.
The results of this study may support this decision. Researchers at half a dozen
major medical centers looked at Medicare claims for patients who had a total
knee replacement (TKR). They found that patients had better results when managed
by doctors who do a high volume of TKRs. Their patients had fewer problems after
the operation.
All patients in the study were over 65 years of age. They were in good health
and only had one knee replaced at the time of the study. Everyone was followed
for at least 90 days. Five specific problems were tracked: death, heart attack,
infection, pneumonia, and blood clot to the lungs. They also looked at the type
of hospital (urban or rural) and how many years the doctor had been practicing.
The authors found that the death rate is 30 percent lower in hospitals where
TKRs are done routinely. The risk of heart attack and lung clots was also lower
in these high volume hospitals. Complications for any medical problem were lower
in high-volume hospitals. Results showed that number of years in practice were
not as important as the number of TKRs done each year.
The authors conclude that patients should be told about treatment options.
High-volume centers may be a good idea, but more research is needed. Long-term
results must be studied before advising that all TKRs should be done at high
volume centers.
Jeffrey N. Katz, MD, MS, et al. Association Between Hospital and Surgeon
Procedure Volume and the Outcomes of Total Knee Replacement. In The Journal of
Bone and Joint Surgery. September 2004. Vol. 86-A. No. 9. Pp.1909-1916.
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