Stay or go? Outcomes of lower limb arthroplasty in patients travelling away from home for surgery: A cross-sectional analysis of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) comparing patient residence and hospital remoteness

Introduction: The relationship between remoteness of patient residence and post-surgical outcomes is yet to be examined. This study aimed to assess whether incidence of all-cause revision up to two years following primary total hip or knee arthroplasty varies with the remoteness of a patient’s residence at the time of surgery. Materials and Methods: Data from the Australian Orthopaedic Association National Joint Replacement Registry from 1-Sep-1999 to 31-Dec-2022 were analysed. The Modified Monash Model of remoteness classification categorised patient residence and hospital location into metro-regional and rural-remote. The primary outcome was all-cause revision within two years after surgery for primary total knee arthroplasty (TKA) and primary total hip arthroplasty (THA) for osteoarthritis as the primary diagnosis. Cumulative percent revision (CPR) rates with 95% confidence intervals (CI) were reported with hazard ratios (HR) between subgroups of residential and hospital remoteness. Results: Two-year CPR for primary TKA ranged from 1.8% (95% CI 1.7–1.9) to 2.2% (95% CI 1.8–2.7). Patients residing in rural-remote areas who travelled to metro-regional hospitals displayed significantly higher CPR following TKA compared to patients treated at rural-remote facilities (HR = 1.11, 95% CI 1.05–1.18, P = 0.001). Patients residing in rural-remote areas that stayed in-area for surgery displayed significantly reduced CPR compared to metro-regional patients that stayed in-area (HR = 0.90, 95%CI 0.85–0.95, P < 0.001). Infection was the dominant reason for TKA revision. No differences in revision risk were observed between patient and hospital combinations for primary THA. Conclusions: Travel distance, but not remoteness of a patient’s residence, may be associated with cumulative risk of early revision of primary TKA, particularly in regional/remote patients travelling out of area, but not for patients undergoing THA. Further work is needed to clarify whether revision differences are due to variability in the clinical threshold for offering revision arthroplasty between regional and metropolitan surgeons, or improved outcomes of the primary procedure.