Exploring the Influence of Surgeon and Hospital Procedural Volume on the Outcomes of Distal Femoral Replacement: An Australian National Joint Replacement Registry Analysis

In total, 1359 DFRs, including 853 primary and 506 revision cases, were analysed. In Australia, 'high-volume' surgeons and hospitals performed less than four DFRs per year. The reoperation rate was significantly lower after revision DFR in high-volume hospitals compared to medium-volume hospitals. There were no other clinically meaningful, significant differences in measured outcomes between low- and high-volume providers, nor between public and private hospitals. Overall, these results suggest minimal difference between low- and high-volume surgeons and hospitals performing DFR in Australia. Despite utilising national registry-level data, these findings may be underpowered by the small differences in volume between low and high-volume providers. Diversion of DFR to specialist providers may help to increase the level of expertise in DFR within Australia, whilst reducing revision rates of revision DFR.