BackgroundArthroscopic surgery is a common treatment for knee osteoarthritis (OA), particularly for symptomatic meniscal tear. Many patients with knee OA who have arthroscopies go on to have total knee arthroplasty (TKA). Several individual studies have investigated the interval between knee arthroscopy and TKA. Our objective was to summarize published literature on the risk of TKA following knee arthroscopy, the duration between arthroscopy and TKA, and risk factors for TKA following knee arthroscopy.MethodsWe searched PubMed, Embase, and Web of Science for English language manuscripts reporting TKA following arthroscopy for knee OA. We identified 511 manuscripts, of which 20 met the inclusion criteria and were used for analysis. We compared the cumulative incidence of TKA following arthroscopy in each study arm, stratifying by type of data source (registry vs. clinical), and whether the study was limited to older patients (≥ 50) or those with more severe radiographic OA. We estimated cumulative incidence of TKA following arthroscopy by dividing the number of TKAs among persons who underwent arthroscopy by the number of persons who underwent arthroscopy. Annual incidence was calculated by dividing cumulative incidence by the mean years of follow-up.ResultsOverall, the annual incidence of TKA after arthroscopic surgery for OA was 2.62% (95% CI 1.73–3.51%). We calculated the annual incidence of TKA following arthroscopy in four separate groups defined by data source (registry vs. clinical cohort) and whether the sample was selected for disease progression (either age or OA severity). In unselected registry studies the annual TKA incidence was 1.99% (95% CI 1.03–2.96%), compared to 3.89% (95% CI 0.69–7.09%) in registry studies of older patients. In unselected clinical cohorts the annual incidence was 2.02% (95% CI 0.67–3.36%), while in clinical cohorts with more severe OA the annual incidence was 4.13% (95% CI 1.81–6.44%). The mean and median duration between arthroscopy and TKA (years) were 3.4 and 2.0 years.ConclusionsClinicians and patients considering knee arthroscopy should discuss the likelihood of subsequent TKA as they weigh risks and benefits of surgery. Patients who are older or have more severe OA are at particularly high risk of TKA.Electronic supplementary materialThe online version of this article (10.1186/s12891-017-1765-0) contains supplementary material, which is available to authorized users.
Total knee arthroplasty and total hip arthroplasty are 2 of the most commonly performed elective orthopaedic procedures. They are remarkably successful in relieving pain and improving function in individuals with advanced, symptomatic arthritis. Since, in addition to providing benefits, these procedures pose risks, it is important to provide clinicians with guidance in determining which patients should undergo total joint replacement surgery. The development of the RAND approach in 1986 and its application to total hip and knee replacement have enabled clinicians, payers, and others to assess the appropriateness of past and current procedures for particular patients. However, current appropriateness criteria for elective orthopaedic procedures have important limitations that suggest that they be used cautiously. New approaches to the assessment of appropriateness that overcome many of these limitations are under development.
Background: Arthroscopic partial meniscectomy (APM) is used to treat meniscal tears, though its efficacy is controversial. Purpose: This study used magnetic resonance imaging (MRI) to determine characteristics that lead to greater benefit from APM and physiotherapy (PT) than from PT alone among patients with meniscal tear and knee osteoarthritis (OA). Study Design: Secondary analysis of data from a randomized clinical trial. Methods: Using data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, we first assessed whether the effect of treatment on pain scores at 6 months differed according to baseline MRI features (bone marrow lesions, cartilage and meniscal damage). Second, we summed MRI features associated with differential pain relief between APM and PT to create a 'Damage Score'. The Damage Score included BML number and cartilage damage size with possible values of 0 (least damage), 1 and 2 (greatest damage). We used linear models to determine whether the association between Damage Score and pain relief at 6 months differed for APM vs. PT. Results: We included 220 participants; 13% had the least damage, 52% moderate damage, and 34% greatest damage. Though treatment type did not significantly modify the association of
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