Arthroscopic Procedures Are Performed in 5% of Patients With Knee Osteoarthritis 1 Year Preceding Total Knee Arthroplasty and Are Associated With Increased Stiffness and Increased Costs

Nin, Darren Z.; Chen, Ya-Wen; Talmo, Carl T.; Hollenbeck, Brian L.; Niu, Ruijia; Chang, David C.; Smith, Eric L.; Mattingly, David

doi:10.1016/j.asmr.2023.100776

Cited by 2 publications

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“…[7][8][9][10] Case series suggest arthroscopic surgery can delay more invasive operations for OA of the knee, such as TKA or osteotomy (limb realignment), and this message is repeated in peer-reviewed journal articles and patient information materials. [17][18][19][20][21][22] Conversely, data from longitudinal cohort studies suggest arthroscopic surgery among patients with or at risk of developing OA of the knee may increase the incidence of TKA when compared with similar patients who did not receive arthroscopic surgery. 23,24 Clinical practice guidelines for OA do not address this discrepancy.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Total Knee Arthroplasty After Arthroscopic Surgery for Knee Osteoarthritis

Birmingham,

Primeau,

Shariff

et al. 2024

JAMA Netw Open

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ImportanceIt is unclear whether arthroscopic resection of degenerative knee tissues among patients with osteoarthritis (OA) of the knee delays or hastens total knee arthroplasty (TKA); opposite findings have been reported.ObjectiveTo compare the long-term incidence of TKA in patients with OA of the knee after nonoperative management with or without additional arthroscopic surgery.Design, Setting, and ParticipantsIn this ad hoc secondary analysis of a single-center, assessor-blinded randomized clinical trial performed from January 1, 1999, to August 31, 2007, 178 patients were followed up through March 31, 2019. Participants included adults diagnosed with OA of the knee referred for potential arthroscopic surgery in a tertiary care center specializing in orthopedics in London, Ontario, Canada. All participants from the original randomized clinical trial were included. Data were analyzed from June 1, 2021, to October 20, 2022.ExposuresArthroscopic surgery (resection or debridement of degenerative tears of the menisci, fragments of articular cartilage, or chondral flaps and osteophytes that prevented full extension) plus nonoperative management (physical therapy plus medications as required) compared with nonoperative management only (control).Main Outcomes and MeasuresTotal knee arthroplasty was identified by linking the randomized trial data with prospectively collected Canadian health administrative datasets where participants were followed up for a maximum of 20 years. Multivariable Cox proportional hazards regression models were used to compare the incidence of TKA between intervention groups.ResultsA total of 178 of 277 eligible patients (64.3%; 112 [62.9%] female; mean [SD] age, 59.0 [10.0] years) were included. The mean (SD) body mass index was 31.0 (6.5). With a median follow-up of 13.8 (IQR, 8.4-16.8) years, 31 of 92 patients (33.7%) in the arthroscopic surgery group vs 36 of 86 (41.9%) in the control group underwent TKA (adjusted hazard ratio [HR], 0.85 [95% CI, 0.52-1.40]). Results were similar when accounting for crossovers to arthroscopic surgery (13 of 86 [15.1%]) during follow-up (HR, 0.88 [95% CI, 0.53-1.44]). Within 5 years, the cumulative incidence was 10.2% vs 9.3% in the arthroscopic surgery group and control group, respectively (time-stratified HR for 0-5 years, 1.06 [95% CI, 0.41-2.75]); within 10 years, the cumulative incidence was 23.3% vs 21.4%, respectively (time-stratified HR for 5-10 years, 1.06 [95% CI, 0.45-2.51]). Sensitivity analyses yielded consistent results.Conclusions and RelevanceIn this secondary analysis of a randomized clinical trial of arthroscopic surgery for patients with OA of the knee, a statistically significant association with delaying or hastening TKA was not identified. Approximately 80% of patients did not undergo TKA within 10 years of nonoperative management with or without additional knee arthroscopic surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT00158431

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Section: Introductionmentioning

confidence: 99%

Incidence of Total Knee Arthroplasty After Arthroscopic Surgery for Knee Osteoarthritis

Birmingham,

Primeau,

Shariff

et al. 2024

JAMA Netw Open

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“…Arthroscopy is widely recognized as the gold standard for diagnosing ACL injuries [ 7 , 8 ]. However, arthroscopy is not only expensive and slow but also traumatic to the patient [ 9 , 10 ]. Magnetic resonance imaging (MRI) is recognized as a non-invasive diagnostic tool for the detection of ACL injuries [ 7 , 11 ], however, have limitations in certain situations, particularly in the context of acute trauma and for participants with specific contraindications [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of the value of dual-energy computed tomography in the diagnosis of anterior cruciate ligament injuries of the knee

Lin,

Wu,

Qiu

2024

BMC Musculoskelet Disord

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Background This meta-analysis assessed the efficacy of dual-energy computed tomography (DECT) in the diagnosis of anterior cruciate ligament (ACL) injuries. Methods The literature search was performed up to December 8, 2023, and included a comprehensive examination of several databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP. Diagnostic metrics sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and a summary receiver operating characteristic (SROC) were determined using a bivariate model analysis. Heterogeneity within the data was explored through subgroup analyses, which considered variables including geographical region, use of magnetic resonance imaging (MRI), arthroscopy, and study design. Results The analysis included ten studies encompassing 544 patients. DECT demonstrated substantial diagnostic utility for ACL injuries of the knee, with a sensitivity of 0.91 (95% confidence interval [CI]: 0.88–0.94), a specificity of 0.90 (95% CI: 0.81–0.95), a PLR of 9.20 (95% CI: 4.50–19.00), a NLR of 0.10 (95% CI: 0.06–0.14), a DOR of 97.00 (95% CI: 35.00–268.00), and an area under the curve (AUC) of 0.95 (95% CI: 0.93–0.97). The subgroup analyses consistently showed high diagnostic precision for ACL injuries across Asian population (sensitivity: 0.91, specificity: 0.91, PLR: 9.90, NLR: 0.09, DOR: 105.00, AUC: 0.96), in MRI subgroup (sensitivity: 0.85, specificity: 0.94, PLR: 9.57, NLR: 0.18, DOR: 56.00, AUC: 0.93), in arthroscopy subgroup (sensitivity: 0.92, specificity: 0.89, PLR: 8.40, NLR: 0.09, DOR: 94.00, AUC: 0.95), for prospective studies (sensitivity: 0.92, specificity: 0.88, PLR: 7.40, NLR: 0.09, DOR: 78.00, AUC: 0.95), and for retrospective studies (sensitivity: 0.91, specificity: 0.93, AUC: 0.93). Conclusion DECT exhibits a high value in diagnosing ACL injuries. The significant diagnostic value of DECT provides clinicians with a powerful tool that enhances the accuracy and efficiency of diagnosis and optimizes patient management and treatment outcomes.

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Arthroscopic Procedures Are Performed in 5% of Patients With Knee Osteoarthritis 1 Year Preceding Total Knee Arthroplasty and Are Associated With Increased Stiffness and Increased Costs

Cited by 2 publications

References 24 publications

Incidence of Total Knee Arthroplasty After Arthroscopic Surgery for Knee Osteoarthritis

Incidence of Total Knee Arthroplasty After Arthroscopic Surgery for Knee Osteoarthritis

Meta-analysis of the value of dual-energy computed tomography in the diagnosis of anterior cruciate ligament injuries of the knee

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