Comparative analysis of total knee arthroplasty in two health care delivery systems.

A prospective, concurrent comparison of patients undergoing total knee arthroplasty in two different health care delivery systems was carried out. All patients had osteoarthritis, and received treatment between September 1983 and September 1987 under the supervision of a single staff physician. There were 26 total knee arthroplasties performed at the University Hospital (UH) and 22 performed at the Department of Veterans Affairs Medical Center (VAMC). The average patient age at the UH was 73 years (range, 58-87 years). The corresponding average age at the VAMC was 67 years (range, 56-78 years). Statistically significant differences between the two health care delivery systems were noted in preoperative length of hospital stay (P less than .001), postoperative length of hospital stay (P less than .001), total length of hospital stay (P less than .001), and postoperative knee range of motion at 1 and 2 years. Overall complications in the UH patient group (23% of knees) were lower than the VAMC (68% of the knees) (P = .05). Our university health care delivery system has both short- and long-term patient benefits as compared to the VAMC studied.