Time trends in case-mix and risk of revision following hip and knee arthroplasty in public and private hospitals: a cross-sectional analysis based on 476,312 procedures from the Dutch Arthroplasty Register

Authors

DOI:

https://doi.org/10.2340/17453674.2024.40906

Keywords:

Arthroplasty, Hip, Independent treatment center, Knee, Private, Public

Abstract

Background and purpose: This study aims to assess time trends in case-mix and to evaluate the risk of revision and causes following primary THA, TKA, and UKA in private and public hospitals in the Netherlands.
Methods: We retrospectively analyzed 476,312 primary arthroplasties (public: n = 413,560 and private n = 62,752) implanted between 2014 and 2023 using Dutch Arthroplasty Register data. We explored patient demographics, procedure details, trends over time, and revisions per hospital type. Adjusted revision risk was calculated for comparable subgroups (ASA I/II, age ≤ 75, BMI ≤ 30, osteoarthritis diagnosis, and moderate–high socioeconomic status (SES).
Results: The volume of THAs and TKAs in private hospitals increased from 4% and 9% in 2014, to 18% and 21% in 2022. Patients in private hospitals were younger, had lower ASA classification, lower BMI, and higher SES compared with public hospital patients. In private hospitals, age and ASA II proportion increased over time. Multivariable Cox regression demonstrated a lower revision risk for primary THA (HR 0.7, CI 0.7–0.8), TKA (HR 0.8, CI 0.7–0.9), and UKA (HR 0.8, CI 0.7–0.9) in private hospitals. After initial arthroplasty in private hospitals, 49% of THA and 37% of TKA revisions were performed in public hospitals.
Conclusion: Patients in private hospitals were younger, had lower ASA classification, lower BMI, and higher SES com­pared with public hospital patients. The number of arthroplasties increased in private hospitals, with a lower revision risk compared with public hospitals.

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References

Dutch Arthroplasty Register (LROI). Annual report. LROI report, 2022. Numbers – LROI Report: Information on orthopaedic prosthesis procedures in the Netherlands Retrieved: 7-2023. Available from: lroireport.nl.

Latijnhouwers D, Pedersen A, Kristiansen E, Cannegieter S, Schreurs B W, van den Hout W, et al. No time to waste; the impact of the COVID-19 pandemic on hip, knee, and shoulder arthroplasty surgeries in the Netherlands and Denmark. Bone Jt Open 2022; 3(12): 977-90. doi: 10.1302/2633-1462.312.BJO-2022-0111.R1. DOI: https://doi.org/10.1302/2633-1462.312.BJO-2022-0111.R1

van Steenbergen L N, Denissen G A, Spooren A, van Rooden S M, van Oosterhout F J, Morrenhof J W, et al. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register. Acta Orthop 2015; 86(4): 498-505. doi: 10.3109/17453674.2015.1028307. DOI: https://doi.org/10.3109/17453674.2015.1028307

von Elm E, Altman D G, Egger M, Pocock S J, Gøtzsche P C, Vandenbroucke J P; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61(4): 344-9. doi: 10.1016/j.jclinepi.2007.11.008. DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008

Dutch Institute of Social Research (SCP). Socioeconomic status score per postal code area [retrieved August, 2023]. Available from: https://bronnen.zorggegevens.nl/Bron?naam=Sociaal-Economische-Status-per-postcodegebied.

Vektis – business intelligence centrum voor de zorg [retrieved July 2023]. Available from www.vektis.nl.

Lacny S, Wilson T, Clement F, Roberts D J, Faris P D, Ghali W A, et al. Kaplan–Meier survival analysis overestimates the risk of revision arthroplasty: a meta-analysis. Clin Orthop Relat Res 2015; 473(11): 3431-42. doi: 10.1007/s11999-015-4235-8. DOI: https://doi.org/10.1007/s11999-015-4235-8

Mahase E. NHS outsourcing to private providers is associated with rise in treatable deaths, study shows. BMJ 2022; 377:o1612. doi: 10.1136/bmj.o1612. DOI: https://doi.org/10.1136/bmj.o1612

White S P, John A W, Jones S A. Short-term results of total hip replacements performed by visiting surgeons at an NHS treatment centre. J Bone Joint Surg Br 2009; 91(9): 1154-7. doi: 10.1302/0301-620X.91B9.22147. DOI: https://doi.org/10.1302/0301-620X.91B9.22147

Oussedik S, Haddad F. Further doubts over the performance of treatment centres in providing elective orthopaedic surgery. J Bone Joint Surg Br 2009; 91(9): 1125-6. doi: 10.1302/0301-620X.91B9.22869. DOI: https://doi.org/10.1302/0301-620X.91B9.22869

Ciampolini J, Hubble M J. Early failure of total hip replacements implanted at distant hospitals to reduce waiting lists. Ann R Coll Surg Engl 2005; 87(1): 31-5. doi: 10.1308/1478708051450. DOI: https://doi.org/10.1308/1478708051450

Harris I, Cuthbert A, Lorimer M, de Steiger R, Lewis P, Graves S E. Outcomes of hip and knee replacement surgery in private and public hospitals in Australia. ANZ J Surg 2019; 89(11): 1417-1423. doi: 10.1111/ans.15154. DOI: https://doi.org/10.1111/ans.15154

Chard J, Kuczawski M, Black N, van der Meulen J; POiS Audit Steering Committee. Outcomes of elective surgery undertaken in independent sector treatment centres and NHS providers in England: audit of patient outcomes in surgery. BMJ 2011; 343:d6404 10.1136/bmj.d6404. doi: 10.1136/bmj.d6404. DOI: https://doi.org/10.1136/bmj.d6404

Holom G H, Hagen T P. Quality differences between private for-profit, private non-profit and public hospitals in Norway: a retrospective national register-based study of acute readmission rates following total hip and knee arthroplasties. BMJ Open 2017; 7(8): e015771. doi: 10.1136/bmjopen-2016-015771. DOI: https://doi.org/10.1136/bmjopen-2016-015771

Street A, Sivey P, Mason A, Miraldo M, Siciliani L. Are English treatment centres treating less complex patients? Health Policy 2010; 94(2): 150–7. doi: 10.1016/j.healthpol.2009.09.013. DOI: https://doi.org/10.1016/j.healthpol.2009.09.013

Winter A. Comparing the mix of patients in various outpatient surgery settings. Health Aff (Millwood) 2003; 22(6): 68-75. doi: 10.1377/hlthaff.22.6.68. DOI: https://doi.org/10.1377/hlthaff.22.6.68

Toetstingkader particuliere klinieken. The Netherlands: Inspectie Gezondheidszorg en Jeugd; 2022 [cited July 2023]. Available from: https://www.igj.nl/publicaties/toetsingskaders/2022/06/01/toetsingskader-particuliere-klinieken.

Peters R M, van Steenbergen L N, Stewart R E, Stevens M, Rijk P C, Bulstra S K, et al. Patient characteristics influence revision rate of total hip arthroplasty: American Society of Anesthesiologists score and body mass index were the strongest predictors for short-term revision after primary total hip arthroplasty. J Arthroplasty 2020; 35(1): 188-192.e2. doi: 10.1016/j.arth.2019.08.024. DOI: https://doi.org/10.1016/j.arth.2019.08.024

Sayed-Noor A S, Mukka S, Mohaddes M, Kärrholm J, Rolfson O. Body mass index is associated with risk of reoperation and revision after primary total hip arthroplasty: a study of the Swedish Hip Arthroplasty Register including 83,146 patients. Acta Orthop 2019; 90(3): 220-5. doi: 10.1080/17453674.2019.1594015. DOI: https://doi.org/10.1080/17453674.2019.1594015

Wall C J, Vertullo C J, Kondalsamy-Chennakesavan S, Lorimer M F, de Steiger R N. A prospective, longitudinal study of the influence of obesity on total knee arthroplasty revision rate: results from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2022; 104(15): 1386-92. doi: 10.2106/JBJS.21.01491. DOI: https://doi.org/10.2106/JBJS.21.01491

Lenguerrand E, Whitehouse M R, Beswick A D, Kunutsor S K, Foguet P, Porter M, et al.; National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales. Lancet Infect Dis 2019; 19(6): 589-600. doi: 10.1016/S1473-3099(18)30755-2. DOI: https://doi.org/10.1016/S1473-3099(18)30755-2

Saylık M, Yenigul A E, Atıcı T. Outcome of mobile and fixed unicompartmental knee arthroplasty and risk factors for revision. J Int Med Res 2022; 50(8): 3000605221115383. doi: 10.1177/03000605221115383 DOI: https://doi.org/10.1177/03000605221115383

van Steenbergen L N, de Reus I M, Hannink G, Vehmeijer S B, Schreurs B W, Zijlstra W P. Femoral head size and surgical approach affect dislocation and overall revision rates in total hip arthroplasty: up to 9-year follow-up data of 269,280 procedures in the Dutch Arthroplasty Register (LROI). Hip Int 2023: 11207000231160223. doi: 10.1177/11207000231160223. DOI: https://doi.org/10.1177/11207000231160223

Van Dooren B, Peters R M, Ettema H B, Schreurs B W, Van Steenbergen L N, Bolder S B T, et al. Revision risk by using the direct superior approach (DSA) for total hip arthroplasty compared with postero-lateral approach: early nationwide results from the Dutch Arthroplasty Register (LROI). Acta Orthop 2023; 94: 158-64. doi: 10.2340/17453674.2023.11959. DOI: https://doi.org/10.2340/17453674.2023.11959

Miller L E, Gondusky J S, Kamath A F, Boettner F, Wright J, Bhattacharyya S. Influence of surgical approach on complication risk in primary total hip arthroplasty. Acta Orthop 2018; 89(3): 289-94. doi: 10.1080/17453674.2018.1438694. DOI: https://doi.org/10.1080/17453674.2018.1438694

Docter S, Philpott H T, Godkin L, Bryant D, Somerville L, Jennings M, et al. Comparison of intra and post-operative complication rates among surgical approaches in total hip arthroplasty: a systematic review and meta-analysis. J Orthop 2020; 20: 310-25. doi: 10.1016/j.jor.2020.05.008. DOI: https://doi.org/10.1016/j.jor.2020.05.008

SooHoo N F, Zingmond D S, Lieberman J R, Ko C Y. Primary total knee arthroplasty in California 1991 to 2001: does hospital volume affect outcomes? J Arthroplasty 2006; 21(2): 199. doi: 10.1016/j.arth.2005.03.027. DOI: https://doi.org/10.1016/j.arth.2005.03.027

Jeschke E, Citak M, Günster C, Matthias Halder A, Heller K D, Malzahn J, et al. Are TKAs performed in high-volume hospitals less likely to undergo revision than TKAs performed in low-volume hospitals? Clin Orthop Relat Res 2017; 475(11): 2669. doi: 10.1007/s11999-017-5463-x. DOI: https://doi.org/10.1007/s11999-017-5463-x

Jeschke E, Gehrke T, Günster C, Heller K D, Leicht H, Malzahn J, et al. Low hospital volume increases revision rate and mortality following revision total hip arthroplasty: an analysis of 17,773 cases. J Arthroplasty 2019; 34(9): 2045-50. doi: 10.1016/j.arth.2019.05.005. DOI: https://doi.org/10.1016/j.arth.2019.05.005

Reidy M J, Faulkner A, Shitole B, Clift B. Do trainee surgeons have an adverse effect on the outcome after total hip arthroplasty?: a ten-year review. Bone Joint J 2016; 98-B(3): 301-6. doi: 10.1302/0301-620X.98B3.35997. DOI: https://doi.org/10.1302/0301-620X.98B3.35997

Inglis T, Dalzell K, Hooper G, Rothwell A, Frampton C. Does orthopedic training compromise the outcome in total hip arthroplasty? J Surg Educ 2013; 70(1): 76-80. doi: 10.1016/j.jsurg.2012.08.003. DOI: https://doi.org/10.1016/j.jsurg.2012.08.003

Storey R, Frampton C, Kieser D, Ailabouni R, Hooper G. Does orthopaedic training compromise the outcome in knee joint arthroplasty? J Surg Educ 2018; 75(5): 1292-8. doi: 10.1016/j.jsurg.2018.02.011. DOI: https://doi.org/10.1016/j.jsurg.2018.02.011

Published

2024-06-17

How to Cite

van Dooren, B.-J., Bos, P., Peters, R. M., van Steenbergen, L. N., De Visser, E., Brinkman, J. M., … Zijlstra, W. P. (2024). Time trends in case-mix and risk of revision following hip and knee arthroplasty in public and private hospitals: a cross-sectional analysis based on 476,312 procedures from the Dutch Arthroplasty Register. Acta Orthopaedica, 95, 307–318. https://doi.org/10.2340/17453674.2024.40906