Road to Total Knee Replacement: Utilization of Knee Surgeries Up to Ten Years Before Total Knee Replacement in England and Sweden

Abstract

Objective. To compare the prevalence and timing of knee surgery (including meniscal, ligamentous, synovial, and osteotomy) in the 10 years prior to primary total knee replacement (TKR) between England and Sweden.Methods. This was a population-based, case-control study within England and southern Sweden using electronic health care databases. Patients underwent primary TKR between 2015 and 2019. Risk-set sampling showed that general population controls matched 1:1 by age, sex, and practice/municipality. The annual prevalence and prevalence ratio of having at least 1 recorded surgery in each of the 10 years preceding TKR was estimated using Poisson regressions.Results. We included 6,308 and 47,010 TKR cases in Sweden and England, respectively. Meniscal surgeries were the most frequent procedure prior to TKR in both countries; prevalence was higher in England across all time points. The prevalence of meniscal surgery increased in both countries in the years approaching TKR, reaching 33.2 (95% confidence interval [95% CI] 31.6-34.9) per 1,000 persons in England, and 9.83 (95% CI 7.66-12.61) in Sweden. In England, we observed a decrease from 2014 to 2018 in the utilization of this procedure in the 4 years preceding a TKR. The prevalence of all analyzed surgeries was consistently lower in controls.Conclusion. There are comparable trends in the use of knee surgery in the years preceding TKR across England and Sweden. Of note, meniscal surgeries remain common, even within the year prior to TKR, highlighting that these patients may experience low-value care. Careful consideration of knee surgery in those with late-stage disease is required.

Incidence of Total Knee Arthroplasty After Arthroscopic Surgery for Knee Osteoarthritis

“…5,6,29,[34][35][36][37][38][39] Patients in this study who underwent arthroscopic surgery had degenerative meniscal tears (>80%) and articular cartilage fragments (>95%) that were partially resected or debrided, and those procedures are consistent with the current, commonly used coding procedures for knee arthroscopic surgery. 6,10,38,69 Our study also has important limitations. It was powered to detect differences in 2-year patientreported outcomes rather than long-term incidence of TKA.…”

“…Knee arthroscopic surgery and total knee arthroplasty (TKA) among patients with knee osteoarthritis (OA) are 2 of the most common orthopedic procedures internationally, with patients frequently undergoing both operations. [1][2][3][4][5][6] Arthroscopic surgery for patients with OA of the knee includes removing the degenerative portions of the menisci, articular chondral fragments, and osteophytes that are thought to contribute to symptoms during a single operation. [7][8][9][10] As partial meniscectomy is known to increase the risk of the development and progression of joint damage, [11][12][13][14][15][16] the aim of arthroscopic surgery for patients with OA of the knee is to resect as little tissue as possible while removing the degenerative portions that contribute to symptoms.…”

“…[25][26][27][28] There are several systematic reviews and recommendations regarding arthroscopic surgery for degenerative knee disease. [29][30][31][32][33] Rates of arthroscopic surgery among patients with OA of the knee remain high internationally, 6,29,[34][35][36][37][38][39][40] including during the years directly preceding TKA. 5,6,41 Rates of TKA are increasing markedly, vary considerably by region, and may be influenced by several factors related to the patients, clinicians, and health systems.…”

“…[29][30][31][32][33] Rates of arthroscopic surgery among patients with OA of the knee remain high internationally, 6,29,[34][35][36][37][38][39][40] including during the years directly preceding TKA. 5,6,41 Rates of TKA are increasing markedly, vary considerably by region, and may be influenced by several factors related to the patients, clinicians, and health systems. 2,[42][43][44][45][46][47][48][49][50] Controlling for these factors in studies is challenging, especially in observational designs, 51,52 and may result in overestimating a causal effect of knee arthroscopic surgery on delaying or hastening TKA.…”

“…Knee arthroscopic surgery and total knee arthroplasty (TKA) among patients with knee osteoarthritis (OA) are 2 of the most common orthopedic procedures internationally, with patients frequently undergoing both operations . Arthroscopic surgery for patients with OA of the knee includes removing the degenerative portions of the menisci, articular chondral fragments, and osteophytes that are thought to contribute to symptoms during a single operation .…”