Rates of knee arthroplasty in patients with a history of arthroscopic chondroplasty: results from a retrospective cohort study utilising the National Hospital Episode Statistics for England

Abstract

ObjectiveThe purpose of this study was to analyse the rate of knee arthroplasty in the population of patients with a history of arthroscopic chondroplasty of the knee, in England, over 10 years, with comparison to general population data for patients without a history of chondroplasty.DesignRetrospective cohort study.SettingEnglish Hospital Episode Statistics (HES) data.Participants and interventionsPatients undergoing arthroscopic chondroplasty in England between 2007/2008 and 2016/2017 were identified. Patients undergoing previous arthroscopic knee surgery or simultaneous cruciate ligament reconstruction or microfracture in the same knee were excluded.OutcomesPatients subsequently undergoing a knee arthroplasty in the same knee were identified and mortality-adjusted survival analysis was performed (survival without undergoing knee arthroplasty). A Cox proportional hazards model was used to identify factors associated with knee arthroplasty. Relative risk of knee arthroplasty (total or partial) in comparison to the general population was determined.ResultsThrough 2007 to 2017, 157 730 eligible chondroplasty patients were identified. Within 1 year, 5.91% (7984/135 197; 95% CI 5.78 to 6.03) underwent knee arthroplasty and 14.22% (8145/57 267; 95% CI 13.94 to 14.51) within 5 years. Patients aged over 30 years with a history of chondroplasty were 17.32 times (risk ratio; 95% CI 16.81 to 17.84) more likely to undergo arthroplasty than the general population without a history of chondroplasty.ConclusionsPatients with cartilage lesions of the knee, treated with arthroscopic chondroplasty, are at greater risk of subsequent knee arthroplasty than the general population and for a proportion of patients, there is insufficient benefit to prevent the need for knee arthroplasty within 1 to 5 years. These important new data will inform patients of the anticipated outcomes following this procedure. The risk in comparison to non-operative treatment remains unknown and there is an urgent need for a randomised clinical trial in this population.

The Long-Term Risk of Knee Arthroplasty in Patients with Arthroscopically Verified Focal Cartilage Lesions

“…Abram et al, in a study of almost 158,000 patients who had undergone previous chondroplasty in U.K. National Health Service (NHS) hospitals, found an increased risk of knee arthroplasty compared with that in the general British population 14 . The overall risk of knee arthroplasty within 8 years was 17.6%.…”

“…Long-term articular cartilage studies have shown that the rate of knee arthroplasty has ranged from 0% to 17% following regenerative cartilage surgical procedures such as microfracture, ACI, chondroplasty, or mosaicplasty [11][12][13][14] . The relative risk of knee arthroplasty in patients with a previous focal cartilage lesion versus the general population remains unknown.…”

After Chondroplasty, Patient Election to Proceed With Cartilage Transplantation Is Closely and Additively Associated With Preoperative AMADEUS (Area Measurement And DEpth Underlying Structure) Grade, Condylar Involvement, Knee Injury and Osteoarthritis Outcome Score Pain Score, and Veterans Rand 12-Item Health Survey Physical Score

“…Chondroplasty as a primary procedure for focal articular cartilage defects has demonstrated inconsistent results in the literature. 9 , 18 , 19 , 20 , 21 Specifically, chondroplasty was not shown to provide symptomatic benefit as compared with observation alone in a randomized controlled trial, 19 or provide significant benefit in delaying arthroplasty. 18 However, other series have suggested that chondroplasty for articular cartilage defects less than 2 cm 2 and in the absence of concurrent meniscal pathology may be efficacious.…”

“… 9 , 18 , 19 , 20 , 21 Specifically, chondroplasty was not shown to provide symptomatic benefit as compared with observation alone in a randomized controlled trial, 19 or provide significant benefit in delaying arthroplasty. 18 However, other series have suggested that chondroplasty for articular cartilage defects less than 2 cm 2 and in the absence of concurrent meniscal pathology may be efficacious. 9 , 21 Given the potential for meaningful clinical benefit and further informed decision-making following direct defect visualization, probing, and chondroplasty at the time of initial diagnostic arthroscopy, a single-stage definitive cartilage restoration procedure (OCA, minced cartilage allograft, etc.)…”

Radiofrequency-Based Chondroplasty Creates a Precise Area of Targeted Chondrocyte Death With Minimal Necrosis Outside the Target Zone: A Systematic Review

“… 9 However, this technique may lead to iatrogenic damage of adjacent healthy tissue, induce localized chondrocyte death, and result in potential disease progression. 10 , 11 Furthermore, mechanical chondroplasty methods have been reported to result in poor-to-moderate clinical outcomes, with no effect on the treatment of arthrosis. 12 , 13 Instead, the instrument itself may cause a “tearing” effect on the cartilage, producing wrinkles and grooves, failing to smoothen the articular surface.…”