Rates of knee arthroplasty within one-year of undergoing arthroscopic partial meniscectomy in England: temporal trends, regional and age-group variation in conversion rates

Abstract

The aim of this study was to determine the proportion of patients undergoing arthroscopic partial meniscectomy (APM) then subsequently receiving a knee arthroplasty within one or two years, with focus on patients over the age of 60 years and regional variation. METHODS Patients undergoing APM in England over 20-years (01-April-1997 to 31-March 2017) were identified in the national Hospital Episode Statistics. The proportion of patients undergoing arthroplasty in the same knee within one or two years of APM was determined and trends were analysed over time nationally and by NHS Clinical Commissioning Group (CCG) region. RESULTS 806,195 APM patients were eligible for analysis with at least one-year of follow up and 746,630 with twoyears. The odds of arthroplasty conversion within one year increased over the study period (OR 3.10 within 1-year in 2014 versus 2000; 95% CI 2.75-3.50). For patients undergoing APM aged 60 years or older in 2015-16, 9.9% (1689/17043; 95% CI 9.5-10.4) underwent arthroplasty within 1-year and, in 2014-15, 16.6% (3100/18734; 95% CI 16.0-17.1) underwent arthroplasty within 2-years. There was greater than 10-fold variation by CCG. CONCLUSIONS Over the study period, the proportion of patients undergoing arthroplasty within one-year of APM increased. In 2015-16, of patients aged sixty years or older who underwent APM, 10% subsequently underwent knee arthroplasty within one year (17% within two years in 2014-15) and there was a high level of regional variation in this outcome. The development and adoption of national treatment guidance is recommended to improve and standardise treatment selection.

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

“… 35 Approximately 10% of patients undergoing meniscectomy require a TKA within 1 year of the initial meniscectomy. 36 , 37 Barnds et al. demonstrated that arthroscopic partial meniscectomy survived 9 months before patients received TKA.…”

The importance of getting it right the first time

“…In this issue of Osteoarthritis and Cartilage, Abram and coworkers report an increase in the proportion of patients undergoing knee arthroplasty (TKR) within 1 or 2 years of arthroscopic partial meniscectomy (APM) 1 . The proportion of patients, all in care funded by the National Health Service in England, undergoing TKR within 1 year of APM increased by 141% between 1997 and 2016.…”

“…How should we interpret the finding that almost 1 out of every 5 patients who undergoes APM ends up having TKR within 2 years of the index surgery? In their publication 1 Findings like these might amplify demands to curtail the autonomy of the orthopedic surgeons in defining the indications for their surgeries. Frontline practitioners have recently issued a consensus statement concluding that knee arthroscopy/APM is still a valid procedure if and when patients are chosen correctly 11 .…”

“…Striving to get it right first time, Abrams and colleagues conclude by recommending the development and adoption of national treatment guidance for arthroscopic meniscal surgery to improve and standardize treatment selection 1,19 . Although we highly commend this initiative, we encourage them to aim higher: There appears to be an urgent need to implement processes to reduce inappropriate arthroscopic knee surgery in the UK.…”

Evidence update: A summary of new evidence to inform treatment decisions for patients with meniscal lesions

“…[11] APM is still commonly performed in patients over the age of 60-years but national data suggests variation in selection criteria and 10-fold regional variation in the proportion of patients receiving a subsequent knee arthroplasty within 1year of APM. [12] To develop evidence-based guidance, a new systematic review was required to summarise the RCT evidence. [13] In this review, the evidence applicable to different groups of patients stratified according to important clinical and radiological criteria was determined.…”