Exploring the Influence of Surgeon and Hospital Procedural Volume on the Outcomes of Distal Femoral Replacement: An Australian National Joint Replacement Registry Analysis

Introduction: High-volume surgeons and hospitals have historically been associated with superior outcomes for high-risk procedures in many surgical domains. It may therefore be reasonable to suggest that patients requiring distal femur replacement (DFR) may show improved outcomes with such providers. This study aimed to describe DFR workload trends and compare outcomes between high- and low-volume surgeons and hospitals. Patients and Methods: Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry for all DFRs performed between 1 January 2003 and 31 December 2021. Low- and high-volume surgeons and hospitals were determined as those below the 10th and above the 90th percentiles, respectively, for mean annual DFR volumes. Cumulative percent revision rates, indications for revision, length of stay, and mortality rates were compared. Results and Conclusions: In total, 1359 DFRs, including 853 primary and 506 revision cases, were analysed. In Australia, ‘high-volume’ surgeons and hospitals performed less than four DFRs per year. The reoperation rate was significantly lower after revision DFR in high-volume hospitals compared to medium-volume hospitals. There were no other clinically meaningful, significant differences in measured outcomes between low- and high-volume providers, nor between public and private hospitals. Overall, these results suggest minimal difference between low- and high-volume surgeons and hospitals performing DFR in Australia. Despite utilising national registry-level data, these findings may be underpowered by the small differences in volume between low and high-volume providers. Diversion of DFR to specialist providers may help to increase the level of expertise in DFR within Australia, whilst reducing revision rates of revision DFR.