Evaluating the impact of revision knee arthroplasty networks in England: an analysis of temporal trends in referral patterns, surgical volumes and early outcomes using hospital episode statistics data for England between 2012 and 2024.
Matthews AH., Gray WK., Evans JP., Briggs T., Porteous A., Phillips J., Alvand A., Bloch B., Baker P., Price A., Toms AD.
BACKGROUND: In 2019, revision knee replacement (RevKR) services in England were reorganised into regional networks following the publication of clinical standards. These networks aim to improve outcomes through multidisciplinary decision-making and minimum surgical activity thresholds. This study examines changes in referral patterns, surgical volumes, and clinical outcomes before and after network implementation. METHODS: RevKR procedures from 1 April 2012 to 31 December 2024 were identified using the Hospital Episode Statistics. Descriptive analysis of patient level national data assessed trends in referral patterns (based on mismatches between patient residence and surgical location), volumes, and outcomes. Low-volume surgeons (<10 cases/year) and units (<30 cases/year) were identified. The primary outcome was one-year re-revision. Secondary outcomes included 90-day mortality, readmissions, and length of stay. RESULTS: Across 67,363 procedures, out-of-area referrals remained stable, with slight increases in London. Since 2021, low-volume practise has declined nationally, particularly in the Northwest, London, and Northeast & Yorkshire. One-year re-revision rates improved from 11.4 % in 2012 to 7.7 % in 2023. However, 90-day mortality rose, possibly due to increasing patient complexity. Some regions showed reduced hospital stays between 2022 and 2024 compared to the pre-COVID era. CONCLUSION: The data suggest early signals of regions aligning with the implementation of revision networks, especially in the Northwest, Northeast & Yorkshire, and London regions. There are encouraging improvements in re-revision rates and hospital stays which may indicate potential benefits of the new model. As revision networks mature, strategies to increase surgical volume may be key to sustaining further improvements in patient outcomes.