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Surgeon volume and early complications after primary total hip arthroplasty

BMJ 2014; 348 doi: (Published 23 May 2014) Cite this as: BMJ 2014;348:g3433
  1. Karl Michaëlsson, professor
  1. 1Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, Uppsala, Sweden
  1. Correspondence to: karl.michaelsson{at}

Surgeons who do at least 35 procedures a year seem safer than surgeons who do fewer

Within the past 50 years, total hip arthroplasty has developed from a procedure with a low success rate to one of the main achievements in surgery and has even been designated the operation of the century.1 The tipping point came during the 1960s, when Sir John Charnley designed and developed a unique well functioning prosthesis and used acrylic bone cement to fix the components. Early (already good) results with this prosthesis have been further improved by later devices. Clinical outcomes are now excellent, and over 95% of modern hip prostheses survive for at least 10 years. Complications do occur, however, and include instability, aseptic loosening, periprosthetic fracture, infection, and occasionally death. Although rare, complications do not happen completely at random, and various patient, surgical, and prosthetic factors have been associated with higher risk.

The linked Canadian register study (doi:10.1136/bmj.g3284) further explores the role of surgeon volume—the number of procedures conducted annually by individual surgeons.2 More specifically, the authors were looking for a volume threshold above which risk of early complications was low for adults having a first total hip replacement for osteoarthritis—the …

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