Comparison of Revision Risk Based on Timing of Knee Arthroscopy Prior to Total Knee Arthroplasty

Abstract

Background: Knee arthroscopy may be performed prior to total knee arthroplasty (TKA) in patients with symptomatic degenerative knee changes that do not yet warrant TKA. The purpose of this study was to determine whether the time interval between knee arthroscopy and subsequent primary TKA is associated with increased rates of revision and certain complications following TKA. Methods: Data from 2006 to 2017 were collected from a national insurance database. Patients who underwent knee arthroscopy within 1 year prior to primary TKA were identified and stratified into the following cohorts based on stratum-specific likelihood ratio (SSLR) analysis: 0 to 15, 16 to 35, 36 to 43, and 44 to 52 weeks from the time of knee arthroscopy to TKA. Univariate and multivariable analyses were conducted to determine the association between these specific time intervals and rates of revision surgery, periprosthetic joint infection (PJI), aseptic loosening, and manipulation under anesthesia. Results: In total, 130,128 patients were included in this study; 6,105 (4.7%) of those patients underwent knee arthroscopy within 1 year prior to TKA and 124,023 (95.3%) underwent TKA without any prior knee surgery, including arthroscopy (the control group). Relative to the control group, the likelihood of undergoing revision surgery was significantly greater in patients who underwent knee arthroscopy ≤15 weeks (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.43 to 2.22; p < 0.001) or 16 to 35 weeks (OR: 1.20; 95% CI: 1.01 to 1.42; p = 0.035) prior to TKA. Patients were at significantly increased risk for PJI if knee arthroscopy was done ≤35 weeks prior to TKA, and all 4 time groups that underwent knee arthroscopy within 1 year before TKA were at increased risk for manipulation under anesthesia. Conclusions: We found a time-dependent relationship between the timing of knee arthroscopy and complications following TKA, with the prevalence of revision surgery and PJI increasing as knee arthroscopy was performed closer to the time of TKA. This study suggests that an interval of at least 36 weeks should be maintained between the 2 procedures to minimize risks of PJI and revision surgery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Knee Arthroscopy Prior to Total Knee Arthroplasty: Temporal Relationship to Surgical Complications

“…Within the past several years, authors have attempted to identify the ideal delay interval between knee arthroscopy and subsequent TKA, if indicated, with many specifying within 6 months as an inflection point, whereby the rates of poor outcomes develop. 4,7,9 However, literature to date is not reflective of the current rates of knee arthroscopies and TKAs. 10 We sought to compare four, timebased cohorts of patients who received a TKA within 24 weeks of an ipsilateral knee arthroscopy, as compared with a control of patients who did not have prior history of knee arthroscopies.…”

“…[14][15][16][17] Prior knee arthroscopy before a TKA may accelerate the development of knee stiffness given the intraarticular nature of knee arthroscopies. 6,7,18 A 2015 report assessing the timing between knee arthroscopy and TKA found that patients who had a knee arthroscopy within 6 months of a TKA had nearly two times increased risk of developing postoperative stiffness, as compared with other time intervals. A recent report by Gu et al 7 also found worse post-TKA outcomes in patients who had a prior knee arthroscopy within 6 months.…”

“…10 A recent study by Gu et al attempted to further explore this temporal relationship by comparing a more specific time interval within a year from TKA. 7 Using national data from 2006 to 2017, they found an increased rate of PJI if a knee arthroscopy was performed within 35 weeks of TKA. However, this study was restricted to Ninth Edition International Classification Codes (ICD) that lack laterality and outcome-specific details that are available with the post-2015, Tenth Edition.…”

“…Furthermore, TKA recipients who have a prior knee arthroscopy may also be at further risk of joint stiffness (arthrofibrosis), prosthetic joint infection (PJI), or revision, as suggested by several recent studies. [3][4][5][6][7][8] However, the temporal relationship between these poor outcomes following TKA and the timing of a prior total knee arthroscopy continues to be debated.…”

Pathogen distrbution and drug resistance in acute, delayed and chronic periprosthetic joint infection: a retrospective analysis of 202 patients

“…There are many kinds of pathogens known to cause PJI. Gram-positive bacteria, especially staphylococcus, are the most common pathogens 3 , followed by Gram-negative bacteria. Although fungal PJIs are rare, they account for less than 1% of postarthroplasty infections.…”