Long term clinical outcome of total knee arthroplasty. The effect of surgeon training and experience

Abstract

Current literature suggests that higher volume Units/Surgeons are usually associated with improved outcomes, due to factors concerning accumulated experience, standardization of protocols and procedures as well as patient-specific particulars. Data widely available from registries of major Healthcare, either Public or Private, Organizations indicate that highly skilled surgeons achieve good outcomes and as they gain experience are better able to select patients suitable for surgery. Accordingly, highly specialized units (training centers, medical schools, centers of Excellence) employing highly qualified and skilled nursing staff, easily achieve higher organizational standards and apply well-established processes, thus diminishing adverse or unpredictable incidents that tend to cause the majority of undesirable outcomes. However, despite these conclusions regarding volume and outcome, little can be said either to promote or renounce the idea of the centralization of knee arthroplasty procedures based on the existing data and the need arises for prospective randomized studies that should address the limitations of the published literature so far.