Temporal trends and regional variation in the rate of arthroscopic knee surgery in England: analysis of over 1.7 million procedures between 1997 and 2017. Has practice changed in response to new evidence?

Abstract

ObjectivesWe investigated trends and regional variation in the rate of arthroscopic knee surgery performed in England from 1997–1998 to 2016–2017.DesignCross-sectional study of the national hospital episode statistics (HES) for England.MethodsAll hospital episodes for patients undergoing a knee arthroscopy between 1 April 1997 and 31 March 2017 were extracted from HES by procedure code. Age and sex-standardised rates of surgery were calculated using Office for National Statistic population data as the denominator. Trends in the rate of surgery were analysed by procedure both nationally and by Clinical Commissioning Group (CCG).ResultsA total of 1 088 872 arthroscopic partial meniscectomies (APMs), 326 600 diagnostic arthroscopies, 308 618 knee washouts and 252 885 chondroplasties were identified (1 759 467 hospital admissions; 1 447 142 patients). The rate of APM increased from a low of 51/100 000 population (95% CI 51 to 52) in 1997–1998 to a peak at 149/100 000 (95% CI 148 to 150) in 2013–2014; then, after 2014–2015, rates declined to 120/100 000 (95% CI 119 to 121) in 2016–2017. Rates of arthroscopic knee washout and diagnostic arthroscopy declined steadily from 50/100 000 (95% CI 49 to 50) and 47/100 000 (95% CI 46 to 47) respectively in 1997–1998, to 4.8/100 000 (95% CI 4.6 to 5.0) and 8.1/100 000 (95% CI 7.9 to 8.3) in 2016–2017. Rates of chondroplasty have increased from a low of 3.2/100 000 (95% CI 3.0 to 3.3) in 1997–1998 to 51/100 000 (95% CI 50.6 to 51.7) in 2016–2017. Substantial regional and age–group variation in practice was detected. In 2016–2017, between 11% (22/207) and 16% (34/207) of CCGs performed at least double the national average rate of each procedure.ConclusionsOver the last 20 years, and likely in response to new evidence, rates of arthroscopic knee washout and diagnostic arthroscopy have declined by up to 90%. APM rates increased about 130% overall but have declined recently. Rates of chondroplasty increased about 15-fold. There is significant variation in practice, but the appropriate population intervention rate for these procedures remains unknown.

Analysis of the trends in arthroscopic meniscectomy and meniscus repair procedures in France from 2005 to 2017

“…In the United States, Abrams et al [13] reported that an increasing number of isolated meniscal repair procedures were done between 2005 and 2011 (11.4% increase in the total number of repairs in this period), without a concurrent increase in the number of meniscectomy procedures in the same period in patients less than 65 years of age. In the United Kingdom, the meniscectomy rate increased considerably from 1998 to 2013 (going from 5.1/10,000 inhabitants to 14.9) and then decreased slightly up to 2017 (to 12/10,000 inhabitants) [14]; however, this study provided no information on the change in the meniscal repair rate. In Denmark, Thorlund et al [15] showed the number of meniscus procedures had doubled between 2000 and 2011 (16.1 to 31.2/10,000 inhabitants), with the largest increase seen in patients > 35 and > 55 years old.…”

“…Conversely, it also reveals a delay in diffusion, acceptance and implementation of research findings supporting no surgical treatment for degenerative meniscal lesions [11,12,17]. However, the results of studies from other countries were generated from a different type of database than the PMSI, thus unrelated to surgical procedure coding by the practitioner (Danish Register for Thorlund et al [15] and Hare et al [16], Pearl Driver for Abrams et al [13] and Hospital Episode Statistics for Abram et al [14]).…”

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

“…We previously reported trends in chondroplasty surgery in England, but data from other countries is not available. 20 The age-sex standardised rate of chondroplasty increased 191% from 17.6/100 000 (95% CI 17.2 to 18.0) in 2007/2008 to 51.2/100 000 (95% CI 50.6 to 51.7) in 2016/2017. 20 The rate of chondroplasty was greatest in patients aged 40 to 59 years (increasing 210% from 34.3/100 000 in 2007/2008 to 106.4/100 000 in 2016/2017.…”

“…20 The age-sex standardised rate of chondroplasty increased 191% from 17.6/100 000 (95% CI 17.2 to 18.0) in 2007/2008 to 51.2/100 000 (95% CI 50.6 to 51.7) in 2016/2017. 20 The rate of chondroplasty was greatest in patients aged 40 to 59 years (increasing 210% from 34.3/100 000 in 2007/2008 to 106.4/100 000 in 2016/2017. 20 In England, although national guidance has been cautiously supportive of radiofrequency chondroplasty for specific indications, there is only limited evidence demonstrating the effectiveness of chondroplasty compared with alternative surgical or non-surgical treatments.…”

A Patient Satisfaction Survey Investigating Pre- and Post-Operative Information Provision in Lower Limb Surgery

“…(7) Additionally, approximately 40,000 meniscal injuries requiring meniscectomy occur in the UK per year. (8) These procedures have also been impacted by overly optimistic expectations, which may lead to longterm dissatisfaction with their outcomes. (9) Previous studies have measured satisfaction as well as functional outcomes or Patient Reported Outcomes (PROs) in lower limb surgery, concluding that three elements are key in maintaining high levels of satisfaction.…”