Quality Statements for Total Knee Replacement
Surgical Volume Quality Statement
Rothman Institute at Jefferson performed 895 total knee replacements (primary and revision) procedures in 2004. Several studies
indicate that this level of volume is generally associated with better patient outcomes.
The National Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS) and the National Institutes of Health (NIH)
Office of Medical Applications of Research (OMAR) convened a consensus development conference to assess scientific knowledge
regarding total knee replacement. After reviewing the Medicare data, it was noted that complication rates are highest in
hospitals that perform less than 25 total knee replacement surgeries per year. The complication rates fall with increases
in numbers of surgeries performed. ( NIH Consensus Development Conference on Total Knee Replacement, December 8-10, 2003, Final Statement)
The Healthcare Cost and Utilization Project (HCUP) Nationwide Impact Sample also noted that hospital volumes of at least 85
total knee replacements per year were associated with lower mortality rates. ( The Journal of Bone and Joint Surgery , September, 2003: 85; 1775-1783)
A study of 80,904 Medicare patients demonstrated that patients receiving primary (first time) total knee replacement in higher-volume
hospitals (hospitals with an annual volume exceeding 200 primary and revision total knee replacement procedures) generally
have lower rates of mortality, pneumonia, and deep knee infection than do patients managed in lower-volume hospitals (hospitals
with an annual volume of 25 primary and revision total knee replacement procedures or fewer). ( The Journal of Bone and Joint Surgery , September, 2004: 85-A(5); 963-74)
Individual Surgeon Volume Quality Statement
One hundred percent (100% ) of the Rothman Institute at Jefferson surgeons who specialize in joint replacement and revision
procedures performed more than 15 total knee replacements in 2004. Numerous studies indicate a link between the number of
surgeries performed and successful results.
Studies have demonstrated an association between higher surgeon volumes and better patient outcomes for total knee replacements.
Surgeon volumes of at least 15 total knee replacements per year were associated with lower mortality rates. ( The Journal of Bone and Joint Surgery . September 2003: 85; 1775-1783)
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Institutes of Health (NIH)
Office of Medical Applications of Research convened a consensus development conference to assess scientific knowledge regarding
total knee replacement. The Medicare data that was reviewed indicated that the highest complication rate is among surgeons
who perform 12 or fewer total knee replacements per year. ( NIH Consensus Development Conference on Total Knee Replacement, December 8-10, 2003, Final Statement)
Physician Board Certification Quality Statement
All 22 Rothman Institute at Jefferson orthopaedic surgeons are board certified or board eligible in Orthopaedic Surgery by
the American Board of Orthopaedic Surgery. Twenty-one surgeons are board certified. One surgeon is board eligible and will
sit for certification as soon as certification period is passed.
A board-certified physician has completed an approved educational training program and an evaluation process including an
examination designed to assess the knowledge, skills, and experience necessary to provide quality patient care in that specialty.
A specialty certificate is issued by a medical specialty certifying board, which is valid nationwide. Although certification
is not required for an individual physician to practice medicine, most hospitals and managed care organizations require that
at least a certain percentage of their staff be “board certified.” ( American Board of Medical Specialties)
