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The SPARK study was initiated to compare primary surgery across three Danish regions with consistently different revision rates. The present study investigated whether the variations were associated with differences in the primary patient selection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective observational cohort study included patients scheduled Sep 2016 Dec 2017 for primary knee arthroplasty (total, medial\/lateral unicompartmental or patellofemoral) at three high\u2010volume hospitals, representing regions with 2\u2010year cumulative revision rates of 1, 2 and 5%, respectively. Hospitals were compared with respects to patient demographics, preoperative patient\u2010reported outcome measures, motivations for surgery, implant selection, radiological osteoarthritis and the regional incidence of primary surgery. Statistical tests (parametric and non\u2010parametric) comprised all three hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline data was provided by 1452 patients (89% of included patients, 56% of available patients). Patients in Copenhagen (Herlev\u2010Gentofte Hospital, high\u2010revision) were older (68.6\u2009\u00b1\u20099 years) than those in low\u2010revision hospitals (Aarhus 66.6\u2009\u00b1\u200910 y. and Aalborg (Fars\u00f8) 67.3\u2009\u00b1\u20099 y., <jats:italic>p<\/jats:italic>\u2009=\u20090.002). In Aalborg, patients who had higher Body Mass Index (mean 30.2\u00a0kg\/m<jats:sup>2<\/jats:sup> versus 28.2 (Aarhus) and 28.7\u00a0kg\/m<jats:sup>2<\/jats:sup> (Copenhagen), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), were more likely to be male (56% versus 45 and 43%, respectively, <jats:italic>p<\/jats:italic>\u2009=\u20090.002), and exhibited fewer anxiety and depression symptoms (EQ\u20105D\u20105L) (24% versus 34 and 38%, <jats:italic>p<\/jats:italic>\u2009=\u20090.01). The preoperative Oxford Knee Score (23.3\u2009\u00b1\u20097), UCLA Activity Scale (4.7\u2009\u00b1\u20092), range of motion (Copenhagen Knee ROM Scale) and patient motivations were comparable across hospitals but varied with implant type. Radiological classification\u2009\u2265\u20092 was observed in 94% (Kellgren\u2010Lawrence) and 67% (Ahlb\u00e4ck) and was more frequent in Aarhus (low\u2010revision) (<jats:italic>p<\/jats:italic>\u2009\u2264\u20090.02), where unicompartmental implants were utilized most (49% versus 14 (Aalborg) and 23% (Copenhagen), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In the Capital Region (Copenhagen), the incidence of surgery was 15\u201328% higher (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patient\u2010reported outcome measures prior to primary knee arthroplasty were comparable across hospitals with differing revision rates. While radiographic classifications and surgical incidence indicated higher thresholds for primary surgery in one low\u2010revision hospital, most variations in patient and implant selection were contrary to well\u2010known revision risk factors, suggesting that patient selection differences alone were unlikely to be responsible for the observed variation in revision rates across Danish hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>II, Prospective cohort study.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07374-3","type":"journal-article","created":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T03:03:16Z","timestamp":1682046196000},"page":"3474-3486","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Hospital variation in revision rates after primary knee arthroplasty was not explained by patient selection: baseline data from 1452 patients in the Danish prospective multicenter cohort study, SPARK"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6743-3316","authenticated-orcid":false,"given":"Anne","family":"M\u00f8rup\u2010Petersen","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Copenhagen University Hospital Herlev and Gentofte Gentofte Hospitalsvej 1 2900 Hellerup Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9976-4865","authenticated-orcid":false,"given":"Michael Rindom","family":"Krogsgaard","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery, Section for Sports Traumatology Bispebjerg and Frederiksberg Hospital, Copenhagen, University of Copenhagen Bispebjerg Bakke 23 2400 Copenhagen NV Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2791-3921","authenticated-orcid":false,"given":"Mogens","family":"Laursen","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Department of Orthopaedic Surgery Aalborg University Hospital Hobrovej 18\u201022 9000 Aalborg Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3335-6719","authenticated-orcid":false,"given":"Frank","family":"Madsen","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Orthopaedic Surgery Aarhus University Hospital Palle Juul\u2010Jensens Boulevard 99 8200 Aarhus N Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2885-9170","authenticated-orcid":false,"given":"Kristian Breds Geoffroy","family":"Mongelard","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Department of 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