Does a surgeon’s hip arthroplasty volume affect outcomes?

Polish version: Czy liczba endoprotez biodra wykonywanych przez chirurga wpływa na wyniki?

Experience matters in hip arthroplasty, but cannot be reduced to a single annual case threshold. A systematic review and meta-analysis published on 20 August 2026 in Archives of Orthopaedic and Trauma Surgery found that some outcomes favoured surgeons performing more total hip arthroplasties (THAs). Definitions of low and high volume varied too much to establish one reliable cutoff.

Why this study matters

Regularly performing a procedure may improve technical consistency, shorten operating time and help surgeons manage unusual situations. However, previous studies defined high volume very differently, from a few or a dozen procedures to more than 100 per year. The review examined annual primary THA volume in relation to revision, complications, readmission, mortality and clinical outcomes.

Review methods

The review followed PRISMA, was registered in PROSPERO and searched Medline and Embase. Eighteen studies involving 796,061 patients were included. All were retrospective, although their methodological quality was rated highly using the selected assessment tool.

Definitions of high volume ranged from a few to more than 100 THAs per year. Nine of the 18 studies used at least 50 procedures annually as one threshold, but this was not a consistent standard across the literature.

Main results

The clearest differences concerned early outcomes. Lower-volume groups had higher odds of readmission within the first month (OR 1.6) and mortality at 3 months (OR 1.8).

There were no statistically significant differences in revision at 3 months, 12 months or beyond 1 year, in readmission at 3 months, or in venous thromboembolism. Many estimates still favoured higher-volume surgeons, but confidence intervals were wide. Only one of the 18 studies reported patient-reported outcomes by surgeon volume, providing little evidence about pain, function or quality of life.

Clinical interpretation for an orthopaedic surgeon

Regular experience with primary THA is probably one contributor to better outcomes, operating within a broader system of care. Higher-volume surgeons often work in specialised hospitals with standardised perioperative pathways, experienced anaesthetic and rehabilitation teams and ready access to complication management. Retrospective data cannot fully separate these influences from patient selection.

Procedure counts are easy to measure, but cannot replace outcomes such as revision, infection, dislocation, function and appropriate selection for surgery.

Limitations

• All studies were retrospective and cannot establish a simple causal relationship.
• Volume definitions differed substantially.
• Surgeon and hospital volume effects were difficult to separate.
• Follow-up periods and complication definitions varied.
• Functional and quality-of-life data were sparse.

Implications for practice

Quality assessment should consider procedural experience alongside implants and surgical approach. The findings may also support concentrating complex cases in teams that regularly perform arthroplasty. They do not define an annual number below which THA is necessarily performed poorly or imply that high volume guarantees a good result. The relative contributions of technique, organisation and patient selection remain uncertain.

References

• Meissner N, Ortwig K, Ramos-Pascual S, Agu C, Stoeve J, Schrednitzki D, Rolvien T, Halder AM. The effect of surgeon volume on outcomes after total hip arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2026;146:308. DOI: 10.1007/s00402-026-06434-w. PubMed PMID 42622668.

The full publication is available open access.

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For Doctors and Physiotherapists · Research Updates, Literature and Evidence-Based Medicine

Content prepared by: Tomasz Poboży - orthopaedic surgeon.