Should you travel away from home for a joint replacement?
A national registry study of Australian hip and knee replacements found that country patients treated close to home did at least as well as those who travelled — and for knees, travelling to a city hospital was associated with slightly more early re-operations.
Disclosure: Dr Broadhead is one of the authors of this study.
Many people living outside the capital cities assume that if they need a hip or knee replacement, the safest thing to do is travel — that a big city hospital must get better results than a regional one. It is a reasonable assumption, and for some patients with complex needs it is true. But for routine joint replacement, is it? This study put the assumption to the test using Australia’s national registry.
What the study looked at
Australia records almost every joint replacement performed in the country in a national registry (the AOANJRR). The researchers examined primary total hip and knee replacements for osteoarthritis from 1999 to 2022, classified both where each patient lived and where they were operated on as metro-regional or rural-remote, and asked a simple question: within two years, how many joints needed a re-operation (a revision)?
That framing separates two things that usually get mixed together — whether you live in the country, and whether you travelled for your surgery.
What it found
Knee replacement: country patients who stayed close to home did well — slightly better, in fact, than city patients treated in the city. Country patients who travelled to metro hospitals had a somewhat higher rate of early re-operation than those treated locally. The absolute numbers were small in every group — roughly 1.8 to 2.2 joints per 100 needing revision within two years — and infection was the most common reason.
Hip replacement: no difference at all, whichever way patients travelled or stayed.
What it means — and what it doesn’t
The honest conclusion is reassurance about local care: nothing in the national data supports the idea that a routine knee or hip replacement done close to home is second-best. For knees, if anything, the opposite signal appeared.
What the study cannot say is why. It is observational — patients were not randomly assigned to stay or travel — so some of the difference may reflect who travels (more complex cases are often sent to the city) or differences in how readily surgeons in different places offer re-operation. The authors say this plainly in the paper.
It also does not mean travelling is wrong for everyone. Some patients genuinely need what only a large metropolitan hospital carries — intensive-care backup for significant medical conditions, or the resources for a complex revision. The Coffs Harbour page describes how that decision is made honestly for Mid North Coast patients: local where local is right, Sydney where Sydney is right.
The bottom line
For a routine hip or knee replacement, being treated close to home is not a compromise — the national registry shows country patients who stayed local did at least as well as anyone. Where you are treated should be decided by your circumstances, not by an assumption that the city is always safer.
Assessing this studyA standardised appraisal for clinicians and registrars — study design, strength and validity.+
Study design
Cross-sectional analysis of the Australian Orthopaedic Association National Joint Replacement Registry (1999–2022), classifying both patient residence and hospital location as metro-regional or rural-remote using the Modified Monash Model, with all-cause revision within two years of primary total hip or knee replacement for osteoarthritis as the outcome.
Level of evidence
OCEBM Level 3 (prognosis) — a whole-of-population observational registry analysis. Group allocation is by circumstance, not randomisation, so associations cannot be read as cause and effect.
Are the results valid?
The registry's near-complete national capture avoids the selection bias of single-centre series, and remoteness was classified with a standard national model. Against that, the analysis is unadjusted for comorbidity and case complexity (sicker or more complex patients may be preferentially sent to the city), a two-year window captures only early revision, and the authors themselves flag that regional and metropolitan surgeons may apply different thresholds for offering revision — any of which could contribute to the observed differences.
What are the results?
For total knee replacement, rural-remote patients who travelled to metro-regional hospitals had a higher two-year cumulative revision rate than those treated at rural-remote hospitals (HR 1.11, 95% CI 1.05–1.18, p = 0.001), and rural-remote patients who stayed in-area had lower revision than metro-regional patients treated in-area (HR 0.90, 95% CI 0.85–0.95, p < 0.001). Absolute two-year revision ranged from 1.8% to 2.2% across groups, with infection the dominant reason. For total hip replacement, no differences were observed between any combination of residence and hospital location.
Do they apply to our patients?
Directly relevant to regional patients weighing local surgery against travelling to a metropolitan centre. The absolute differences are small and the design cannot prove mechanism, so the honest reading is reassurance about local care rather than a warning against cities — and some patients (complex revisions, significant medical comorbidity) are still best treated where greater hospital resources exist. Disclosure — Dr Broadhead is an author of this study.
Bottom line
Whole-of-population registry data give no support to the idea that country patients must travel to a city for a routine joint replacement — knee replacement close to home was associated with equal or slightly lower early revision, and hip replacement showed no difference either way.
Framework: study design graded with the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence; validity and applicability appraised in the CASP tradition.
This is a plain-language summary of published research, provided for general education. It is not medical advice and does not describe Dr Broadhead's own results. Whether any finding applies to you depends on your individual circumstances — please discuss your care with your treating team.