Trends in elective knee arthroscopies in a population‐based cohort, 2000–2009

Bohensky, Megan; Sundararajan, Vijaya; Andrianopoulos, Nick; Steiger, Richard N. de; Bucknill, Andrew; Kondogiannis, Christos M; McColl, Geoff; Brand, Caroline

doi:10.5694/mja11.11645

Cited by 42 publications

(41 citation statements)

References 20 publications

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“…The decreasing rate of knee arthroscopy was also noted in a review of case logs for the American Board of Orthopaedic Surgery [26]. Another Australian study found an overall reduction of elective knee arthroscopy procedures in Victorian hospitals from 2000–2009 [27]. …”

Section: Discussionmentioning

confidence: 87%

Trends in knee arthroscopy and subsequent arthroplasty in an Australian population: a retrospective cohort study

Harris

Madan

Naylor

et al. 2013

BMC Musculoskelet Disord

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BackgroundKnee arthroscopy is a common procedure in orthopaedic surgery. In recent times the efficacy of this procedure has been questioned with a number of randomized controlled trials demonstrating a lack of effect in the treatment of osteoarthritis. Consequently, a number of trend studies have been conducted, exploring rates of knee arthroscopy and subsequent conversion to Total Knee Arthroplasty (TKA) with varying results. Progression to TKA is seen as an indicator of lack of effect of primary knee arthroscopy.The aim of this paper is to measure overall rates of knee arthroscopy and the proportion of these patients that undergo subsequent total knee arthroplasty (TKA) within 24 months, and to measure trends over time in an Australian population.MethodsWe conducted a retrospective cohort study of all adults undergoing a knee arthroscopy and TKA in all hospitals in New South Wales (NSW), Australia between 2000 and 2008. Datasets obtained from the Centre for Health Record Linkage (CHeReL) were analysed using negative binomial regression. Admission rates for knee arthroscopy were determined by year, age, gender and hospital status (public versus private) and readmission for TKA within 24 months was calculated.ResultsThere was no significant change in the overall rate of knee arthroscopy between 2000 and 2008 (-0.68%, 95% CI: -2.80 to 1.49). The rates declined in public hospitals (-1.25%, 95% CI: -2.39 to -0.10) and remained relatively steady in private hospitals (0.42%, 95% CI: -1.43 to 0.60). The proportion of patients 65 years or over undergoing TKA within 24 months of knee arthroscopy was 21.5%. After adjusting for age and gender, there was a significant decline in rates of TKA within 24 months of knee arthroscopy for all patients (-1.70%, 95% CI:-3.13 to -0.24), patients admitted to private hospitals (-2.65%, 95% CI: -4.06 to -1.23) and patients aged ≥65 years (-3.12%, 95% CI: -5.02 to -1.18).ConclusionsRates of knee arthroscopy are not increasing, and the proportion of patients requiring a TKA within 24 months of a knee replacement is decreasing in the age group most likely to have degenerative changes in the knee.

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Section: Discussionmentioning

confidence: 87%

Trends in knee arthroscopy and subsequent arthroplasty in an Australian population: a retrospective cohort study

Harris

Madan

Naylor

et al. 2013

BMC Musculoskelet Disord

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“…[15][16][17][18] Arthroscopic procedures for degenerative knee disease cost more than $3bn per year in the US alone. 19 A high prevalence of features advocated to respond positively to arthroscopic surgery (such as meniscal tears, mechanical symptoms, and sudden symptom onset) as well as financial incentives may explain why arthroscopic knee surgery continues to be so common despite recom- • Degenerative knee disease is an inclusive term, which many consider synonymous with osteoarthritis.…”

Section: Understanding the Recommendationsmentioning

confidence: 99%

Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline

Siemieniuk

Harris

Agoritsas

et al. 2017

BMJ

166

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“…[41][42][43] For example, a placebo-controlled trial published in 2002, demonstrating a lack of effect of arthroscopic debridement, washout, or both for knee OA, 41 along with subsequent confirmatory studies, 44,45 has failed to consistently reduce arthroscopy rates for knee OA over the past decade. [46][47][48] Overall ambulatory arthroscopy rates in the USA actually increased by almost 50% between 1996 and 2006, 49 owing to a substantial increase in arthro scopy for meniscal tears, particularly among middle-aged patients, even though the value of arthroscopic debridement for degenerative meniscal tears in people with or without knee OA has also been questioned. [50][51][52][53][54] Several studies have demonstrated delays in the instigation of effective treatments for RA, despite the availability of evidence consistently supporting early intensive therapy.…”

Section: Increasing the Value Of Clinical Researchmentioning

confidence: 97%

Setting the research agenda for improving health care in musculoskeletal disorders

2015

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Despite a substantial contribution to the global burden of disease, musculoskeletal conditions are under-represented in clinical research, and that which is performed is often wasteful and lacking clinical relevance. Even clinically relevant musculoskeletal research might not lead to timely or adequate changes in clinical practice and associated improvements in patient outcomes. The formulation of clinical recommendations alone is usually insufficient to bring about changes in practice patterns. Research exploring how to improve the translation of evidence-based recommendations into practice, as well as the identification and removal of barriers to practice change, is necessary in order for the promise of musculoskeletal research to be realized in improved health outcomes. These goals can be achieved by improvements in the coordination of research activities, the resourcing and allocation of funding, and the involvement of clinicians and patients.

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Trends in elective knee arthroscopies in a population‐based cohort, 2000–2009

Abstract: The overall rate of elective knee arthroscopy in Victorian hospitals has decreased. There has been no sustained reduction in arthroscopy use for people with a concomitant diagnosis of OA, despite published evidence questioning the effectiveness of the procedures.

Cited by 42 publications

References 20 publications

Trends in knee arthroscopy and subsequent arthroplasty in an Australian population: a retrospective cohort study

Trends in knee arthroscopy and subsequent arthroplasty in an Australian population: a retrospective cohort study

Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline

Setting the research agenda for improving health care in musculoskeletal disorders

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