Rates and Risk Factors of Revision Arthroscopy or Conversion to Total Knee Arthroplasty Within 1 Year Following Isolated Meniscectomy

Abstract

Purpose To identify the rates of and risk factors for revision arthroscopy and conversion to total knee arthroplasty (TKA) within 1 year of isolated meniscectomy. Methods Humana and Medicare national insurance databases were queried for patients who underwent isolated meniscectomy. Patients who underwent revision arthroscopy or TKA within 1 year postoperatively were identified by International Classification of Diseases Procedural Codes, Ninth Revision, and Current Procedural Terminology codes. Multivariate binomial logistic regression analysis was used to identify risk factors, and adjusted odds ratios (ORs) and 95% confidence intervals (Cis) were calculated, with P < .05 considered significant. Results A total of 13,142 patients and 407,888 patients underwent isolated meniscectomy in the Humana and Medicare databases, respectively. Of the patients, 395 (3.01%) and 3,770 patients (0.92%) underwent revision arthroscopy, and 629 patients (4.79%) and 38,630 patients (9.47%) underwent TKA within 1 year of meniscectomy in the Humana and Medicare databases, respectively. Obesity (Humana: OR = 1.33, P = 0.003; Medicare: OR = 1.10, P < 0.001) and age < 20 years (Humana: OR = 2.64, P = 0.022), 20-29 years (Humana: OR = 3.30, P = 0.002), 40-49 years (Humana: OR = 3.80, P < 0.001), 50-59 years (Humana: OR = 1.99, P = 0.027), and < 64 years (Medicare: OR = 1.74, P < 0.001) were risk factors for revision arthroscopy. Obesity (Humana: OR = 1.64, P < 0.001; Medicare: OR = 1.37, P < 0.001), morbid obesity (Medicare: OR = 1.20, P < 0.001), age 70-74 (Medicare: OR = 1.12, P < 0.001), 75-79 (Medicare: OR = 1.25, P < 0.001), 80-84 (Medicare: OR = 1.20, P < 0.001), and concomitant osteoarthritis (Humana: OR = 1.42, P < 0.001; Medicare: OR = 1.46, P < 0.001) were risk factors for conversion to TKA. Conclusions Medicare and Humana databases showed that 0.92%-3.01% and 4.79%-9.47% of patients undergo revision arthroscopy or conversion to TKA within a year of isolated meniscectomy. Obesity was a risk factor for early revision arthroscopy and conversion to TKA, whereas concomitant osteoarthritis was a risk factor for conversion to TKA. Level of Evidence Level III, retrospective comparative trial .

Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

“…Postoperative adverse events in patients undergoing TKA may increase the probability of disability and affect the quality of recovery. Previous investigations have reported the adverse events and serious adverse events ranging from 1 month to several years in duration [5][6][7]. Patients in the ambulatory setting cannot rely on hospital support (e.g., nurses, intravenous medications) to manage their postoperative recovery and are expected to provide self-care after surgery [8].…”

The Relationship Between the Timing of Knee Osteoarthritis Diagnoses and Arthroscopic Partial Meniscectomy

“…34,35 APM in knees with OA is also associated with early conversion to TKA and substantially greater TKA utilization rates in general compared with those who did not undergo APM. 36,37 A recent meta-analysis also concluded that the harm far outweighs the benefits of APM in patients with OA. 38 With over 700,000 APMs conducted annually in the United States alone and $4 billion estimated annual direct medical costs, the question of cost-effectiveness must be addressed.…”

“…34,35 APM in knees with OA is also associated with early conversion to TKA and substantially greater TKA utilization rates in general compared with those who did not undergo APM. 36,37 A recent meta-analysis also concluded that the harm far outweighs the benefits of APM in patients with OA. 38…”

The Conversion Rate of Arthroscopy to Total Joint Arthroplasty in Patients with Knee Osteoarthritis

“…Moreover, it was reported that after arthroscopic meniscectomy, patients may have a higher risk of worsening cartilage damage and for developing late onset OA. (19) However, the impact of arthroscopy on the progression of an already diagnosed knee OA is not clear yet. The general consensus is that degenerative meniscal tears, without symptoms of locking and catching, can be successfully treated by exercise therapy as a first line treatment since arthroscopic surgery is not able to provide better outcomes up to middle term evaluation.…”

“…For the time being, patients and specialists should be aware of the higher risk for knee replacement surgery after arthroscopic meniscectomy and weigh carefully all the possible negative consequences before choosing any treatment. (19)(20)(21) Several studies, based on the information provided by the Osteoarthritis Initiative (OAI) cohort, have tried to identify the factors that could predict the conversion to KA after arthroscopic surgery (table no. 1).…”