Arthroscopic procedures could delay the need for a subsequent knee arthroplasty in older patients with end-stage osteoarthritis

Abstract

Background/objective: Arthroscopic surgery in knee osteoarthritis is controversial with many studies refuting its efficacy in recent literature. This study aims to evaluate the mean duration to knee arthroplasty, and the effect of microfracture on the need for subsequent knee arthroplasty in patients above the age of 55 undergoing arthroscopic procedures for osteoarthritis. Methods: One hundred and nine consecutive patients with diagnosed osteoarthritis who underwent arthroscopic surgery performed from January 2000 to December 2012 on patients aged 55 years and above by a single surgeon were reviewed retrospectively. Demographic data, age at operation, comorbidities, perioperative details and information of subsequent total knee arthroplasty were collected and analysed. Results: There were 38 males and 71 females in our study group. The group was predominantly Chinese (51.38%), with hypertension and hyperlipidaemia being the most common comorbidities, each affecting 57.8% of our study cohort. All patients had a preoperative radiograph and a magnetic resonance imaging confirming the diagnosis of osteoarthritis associated with meniscal tears. Fifty-eight knees underwent microfracture along with arthroscopic meniscectomy. The mean follow-up duration was 127.5 months (10.5 years, range: 67-212 months). Twenty three patients (20.91%) underwent knee arthroplasties subsequently, with the mean duration to arthroplasty being 65.0 months (5.5 years, range: 7-166 months). The odds ratio of avoiding knee arthroplasty with microfracture was 1.03 (95% CI ¼ 0.410-2.581). Conclusion: Arthroscopic procedures could possibly delay the need for subsequent knee arthroplasty for approximately 65 months in older patients with osteoarthritis. However, microfracture does not affect the duration between therapeutic arthroscopy and subsequent arthroplasty. Our long-term retrospective study provides an additional step in the understanding of the impact of arthroscopic procedures and a prospective case-control study would be an ideal follow-up to fully justify the application of arthroscopic procedures to delay knee arthroplasty.

Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm

“…Lateral wedge insoles have been found to reduce MME and could also supplement a conservative treatment of knee OA, as they could potentially delay the degenerative process [ 50 ]. However, arthroscopic debridement and osteotomies around the knee are also being employed in some instances in moderate knee OA before a TKR is required [ 51 , 52 ]. Wang et al [ 53 ], in a retrospective review of 131 patients who had undergone arthroscopic surgery for knee OA and were followed up for 4 years, found that in regard to pain relief, arthroscopic surgery was also beneficial in patients with major MME (> 3 mm).…”

Incidence of Total Knee Arthroplasty After Arthroscopic Surgery for Knee Osteoarthritis

“…[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.…”