How Safe Is Primary Knee Replacement Surgery? Perioperative Complication Rates in Northern Illinois, 1993-1999

Joe Feinglass*, Hagay Amir, Patricia Taylor, Ithai Lurie, Larry M. Manheim, Rowland W. Chang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Objective. To describe inpatient complications for primary total knee replacement (TKR) in a period of rapidly growing orthopedic surgery capacity, declining length of stay, and more frequent discharge to rehabilitation facilities. Methods. Complication incidence according to published coding algorithms was estimated for 35,531 primary TKR admissions of northern Illinois residents to 65 Illinois hospitals. Complication odds were estimated as a function of patients' clinical and sociodemographic status, hospital volume, residency training, TKR length of stay, International Classification of Diseases, Ninth Revision (ICD-9) coding intensity, and discharges to skilled nursing or rehabilitation facilities. Results. Primary TKR admissions increased 36% between 1993 and 1999, length of stay declined 43%, average ICD-9 code use increased 31%, and rehabilitation discharges increased 68%. Major complication rates declined 44% (12.4% to 6.9%; P < 0.0001) over this period, reflecting a 50% reduction in the adjusted odds of complication between 1993 and 1999. There was no association of procedure volume and outcome. Conclusion. It is likely that the reduction in complications reflects true safety improvements as well as reduced length of stay.

Original languageEnglish (US)
Pages (from-to)110-116
Number of pages7
JournalArthritis Care and Research
Issue number1
StatePublished - Feb 15 2004


  • Arthritis
  • Complications
  • Joint replacement surgery
  • Patient safety

ASJC Scopus subject areas

  • Rheumatology


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