Lower nationwide rates of arthroscopic procedures in 2016 compared with 1997 (634925 total arthroscopic procedures): has the tide turned?

Abstract

ObjectivesTo assess the rates and secular trends of different joint arthroscopies—shoulder, elbow, wrist, hip, knee and ankle—in Finland between 1997 and 2016.DesignRetrospective nationwide registry study.ParticipantsAll adults in Finland with any arthroscopic intervention procedure code for knee, shoulder, ankle, wrist, elbow or hip arthroscopy between 1 January 1997 and 31 December 2016 were included.Main outcome measuresIncidence rate of arthroscopic surgery per 100 000 person-years.ResultsThe rate of knee and shoulder arthroscopies declined after reaching a peak in 2006 and 2007, respectively. The rates of wrist, elbow and hip joint arthroscopies declined after their 2014 peak. At the same time, the median age of patients who had knee, ankle and hip arthroscopy decreased, whereas the age of patients who had shoulder arthroscopy increased.ConclusionsNumerous randomised controlled trials point to lack of efficacy of the most common knee and shoulder arthroscopic procedures. It should not be assumed that this has contributed to decreased rates of arthroscopic surgery. The concurrent decrease in most of the other joint arthroscopic procedures was unexpected.

Knee arthroscopy: evidence for a targeted approach

“…To our interpretation, recent BJSM publications appear to take an emotional stance, indicating that all arthroscopy for conditions that cause joint pain is bad and should be stopped. 1 2 Following an article reporting a decline in the rate of arthroscopy in Finland, 3 Ardern et al provided a provocative editorial citing reasons for this change as reduced reimbursement, medical overuse and grass roots pressure. 1 Scientific evidence was not one of the five reasons given directly.…”

When taking a step back is a veritable leap forward. Reversing decades of arthroscopy for managing joint pain: five reasons that could explain declining rates of common arthroscopic surgeries

“…By the end of the 20th century, knee, shoulder, hip and ankle arthroscopies were some of the most frequently performed surgeries in developed countries. 1 Questions were first raised about the efficacy of knee arthroscopy for advanced osteoarthritis in 2002, when Professor Moseley and colleagues published their landmark placebo-controlled trial. 2 Similarly, rigorous trials followed, each questioning the efficacy of arthroscopic partial meniscectomy and subacromial decompression—the two most common arthroscopic surgeries.…”

“…Despite compelling, high-quality evidence, why did the number of arthroscopies for degenerative conditions continue to rise in the first decade of the 21st century? 1 The most obvious change to clinical practice was that arthroscopies were increasingly billed using different procedure (billing) codes. 3 Our Finnish colleagues investigated the trends in various arthroscopic surgeries in Finland between 1997 and 2016 and found that the incidence of knee and shoulder arthroscopy peaked in 2006 and 2007, respectively, then steadily declined.…”

“… 3 Our Finnish colleagues investigated the trends in various arthroscopic surgeries in Finland between 1997 and 2016 and found that the incidence of knee and shoulder arthroscopy peaked in 2006 and 2007, respectively, then steadily declined. 1 The rates of wrist, elbow and hip arthroscopies also declined after their 2014 peak. 1 Although the rates have declined in some countries, arthroscopies for patients with degenerative joint diseases remain some of the most commonly performed surgeries around the world.…”

“… 1 The rates of wrist, elbow and hip arthroscopies also declined after their 2014 peak. 1 Although the rates have declined in some countries, arthroscopies for patients with degenerative joint diseases remain some of the most commonly performed surgeries around the world.…”