Last reviewed: September 29, 2026

Yes, somewhat. Surgeons and hospitals that do more knee replacements have slightly fewer problems on average.

In the American joint replacement registry, patients whose surgeon and hospital both did few knee replacements had more redo operations for all causes, including early ones for infection, and more deaths within three months. In the Australian registry, redo operations for infection in the first year were about 1 in 250 for surgeons who did 100 or more a year, compared with about 1 in 170 for surgeons who did fewer than 25.

A review of 68 studies found that higher-volume hospitals had slightly fewer deaths and readmissions in the first three months. It found no clear difference in infection or in redo operations years later.

There is no agreed minimum. Studies that looked for a cut-off found different numbers: about 50 to 260 a year for surgeons and about 75 to 235 a year for hospitals. The risk was highest at the lowest volumes and levelled off as volume rose. In Germany, redo operations within a year were predicted at about 1 in 28 for hospitals doing 50 a year and about 1 in 38 for hospitals doing 250.

Leapfrog, a US group that rates hospitals, sets 50 a year for hospitals and 25 for surgeons. Germany requires hospitals to do at least 150 a year. These numbers are set by policy. Studies have not shown which minimum is best.

Whether fellowship training in joint replacement matters on its own is less clear. One large US study found fewer infections and redo operations with fellowship-trained surgeons. Two others found no difference in early complications. Fellowship-trained surgeons also do many more knee replacements, which may explain part of the difference.

All of these studies are observational. They show a link, not proof that volume itself is the cause.

In general:

  • Ask your surgeon how many knee replacements they do each year.
  • Ask how many knee replacements are done each year at the hospital where your surgery will be done.
  • Ask your surgeon what their complication rate is.

Drafted with AI assistance from published sources, reviewed and edited by Babak Sheikh, MD.

Sources:

  • Siddiqi A, et al. Effects of Hospital and Surgeon Volume on Patient Outcomes After Total Joint Arthroplasty: Reported From the American Joint Replacement Registry. J Am Acad Orthop Surg. 2022. https://doi.org/10.5435/JAAOS-D-21-00946
  • Vaotuua D, et al. The Effect of Surgeon Volume on Revision for Periprosthetic Joint Infection: An Analysis of 602,919 Primary Total Knee Arthroplasties. J Bone Joint Surg Am. 2023. https://doi.org/10.2106/JBJS.22.01351
  • Kugler CM, et al. Hospital Volume-Outcome Relationship in Total Knee Arthroplasty: A Systematic Review and Dose-Response Meta-Analysis. Knee Surg Sports Traumatol Arthrosc. 2022. https://doi.org/10.1007/s00167-021-06692-8
  • Wilson S, et al. Meaningful Thresholds for the Volume-Outcome Relationship in Total Knee Arthroplasty. J Bone Joint Surg Am. 2016. https://doi.org/10.2106/JBJS.15.01365
  • Yu TH, et al. Should We Pay Attention to Surgeon or Hospital Volume in Total Knee Arthroplasty? Evidence From a Nationwide Population-Based Study. PLoS One. 2019. https://doi.org/10.1371/journal.pone.0216667
  • Pappas MA, et al. Volume and Outcomes of Joint Arthroplasty. J Arthroplasty. 2022. https://doi.org/10.1016/j.arth.2022.05.011
  • Roessler M, et al. Investigating Non-Linear Volume-Outcome Relationships in Total Knee Arthroplasty Based on a Sample of More Than 60,000 Hospital Cases From Germany, 2020–2023. Sci Rep. 2026. https://doi.org/10.1038/s41598-026-48939-9
  • Katanbaf R, et al. Fellowship Training in Adult Reconstruction Is Associated With Decreased Complications Up to Two Years Following Total Knee Arthroplasty. J Arthroplasty. 2026. https://doi.org/10.1016/j.arth.2025.09.040
  • Gordon AM, et al. Which Surgeon Demographic Factors Influence Postoperative Complication Rates After Total Knee Arthroplasty at U.S. News and World Report Top-Ranked Orthopedic Hospitals? Arthroplasty. 2022. https://doi.org/10.1186/s42836-022-00125-8
  • Pour AE, et al. Trends in Primary and Revision Knee Arthroplasty Among Orthopaedic Surgeons Who Take the American Board of Orthopaedics Part II Exam. Int Orthop. 2016. https://doi.org/10.1007/s00264-016-3137-z

This is general information about what published research shows. It is not medical advice and it is not about your situation. Reading it does not create a doctor-patient relationship with me. I am a retired orthopedic surgeon and I do not see patients. Talk with your own doctor before changing anything about your care. If something feels suddenly or seriously wrong, get medical care promptly rather than waiting.

This page is provided as is. I make no guarantee that it is accurate, complete or current, and medical evidence changes. Use of it is at your own risk.

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