Abstract
BackgroundTotal knee arthroplasty (TKA) is performed to treat end-stage knee osteoarthritis. In Germany, a minimum volume threshold of 50 TKAs/hospital/year was implemented to ensure outcome quality. This study, embedded within a systematic review, aimed to investigate the perspectives of potential TKA patients on the hospital volume-outcome relationship for TKA (higher volumes associated with better outcomes).MethodsA convenience sample of adults with knee problems and heterogeneous demographic characteristics participated in the study. Qualitative data were collected during a focus group prior to the systematic review (n = 5) and during telephone interviews, in which preliminary results of the systematic review were discussed (n = 16). The data were synthesised using content analysis.ResultsAll participants (n = 21) believed that a hospital volume-outcome relationship exists for TKA while recognising that patient behaviour or the surgeon could also influence outcomes. All participants would be willing to travel longer for better outcomes. Most interviewees would choose a hospital for TKA depending on reputation, recommendations, and service quality. However, some would also choose a hospital based on the results of the systematic review that showed slightly lower mortality/revision rates at higher-volume hospitals. Half of the interviewees supported raising the minimum volume threshold even if this were to increase travel time to receive TKA.ConclusionsPotential patients believe that a hospital volume-outcome relationship exists for TKA. Hospital preference is based mainly on subjective factors, although some potential patients would consider scientific evidence when making their choice. Policy makers and physicians should consider the patient perspectives when deciding on minimum volume thresholds or recommending hospitals for TKA, respectively.
Highlights
Total knee arthroplasty (TKA) is performed to treat end-stage knee osteoarthritis
The study is embedded within our systematic review of the hospital volume-outcome relationship for TKA (PROSPERO protocol CRD42019131) [8], in which we aim to investigate and quantify the relationship between hospital volume and patient-relevant outcomes following TKA
We introduced the term TKA at the beginning of the focus group and the interviews but referred to the procedure using the more general term ‘knee joint surgery’ throughout the study to improve the understanding of the participants. † Added during the focus group
Summary
Total knee arthroplasty (TKA) is performed to treat end-stage knee osteoarthritis. In Germany, a minimum volume threshold of 50 TKAs/hospital/year was implemented to ensure outcome quality. Total knee arthroplasty (TKA) is a successful therapy for end-stage knee osteoarthritis, resulting in pain relief and functional improvement [2]. There are two hypotheses to explain the association between higher hospital volumes and better health outcomes. According to the first hypothesis (“practice makes perfect”), higher hospital volumes result in greater experience and better skills of the entire team [4, 5, 10] and in greater standardisation of processes [9]. Higher volumes lead to better health outcomes. Good health outcomes lead to higher volumes in such hospitals [4]. The reasons why high-volume hospitals achieve better outcomes are still not fully understood [9]
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