The effect of surgeon volume on outcomes after total hip arthroplasty: a systematic review and meta-analysis

Abstract

To synthesize, critically appraise and systematically review studies comparing outcomes after primary total hip arthroplasty (THA) performed by low- vs. high-volume surgeons, and to propose evidence-based threshold definitions for these categories. This review followed the PRISMA guidelines and was registered in PROSPERO. Medline and Embase were searched on March 24, 2025. Prospective and retrospective clinical studies were included if they reported THA thresholds for low- and high-volume surgeons. Articles not written in English or German were excluded. Outcomes were pooled and presented in forest plots. Methodological quality was assessed. Of 872 identified articles, 18 were included, reporting on 796,061 patients undergoing THA. Methodological quality was high in all studies (>6 of 7 points). Thresholds used to define high- vs. low-volume were determined using arbitrary values (n = 11), tertiles (n = 1), quartiles (n = 3), percentiles (n = 2), or receiver operating characteristic curves (n = 1). High-volume surgeons had significantly lower 1-month readmission rates [odds ratio (OR) = 1.6; p = 0.033] and 3-month mortality rates (OR = 1.8; p = 0.008). In contrast, there were no significant differences between high- and low-volume surgeons for 3-month revision rates (OR = 2.0; p = 0.228), 12-month revision rates (OR = 1.8; p = 0.228), and 3-month readmission rates (OR = 1.3; p = 0.337). The included studies demonstrated considerable variability in the definitions of surgeon volume. However, there remains a trend suggesting that higher-volume surgeons experience fewer revisions, complications, readmissions, and mortality; although these differences were largely not statistically significant. Nonetheless, surgeon volume may not be the only factor influencing outcomes, as hospital and patient characteristics may influence short- to long-term outcomes following primary THA.