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

Abstract

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.

Age-Related Trends in Hip Arthroscopy: A Large Cross-Sectional Analysis

“…30,31 In a large cohort study of 121,115 knee arthroscopies from Australia, 7.5% of all patients and 21.5% of patients >65 years old required conversion to total knee arthroplasty within 24 months of knee arthroscopy. 32 Before the introduction of new coding for cam decompression, pincer decompression, and labral repair in 2011, the most commonly coded procedure was CPT 29862 (chondroplasty/abrasion arthroplasty and/or debridement of labrum). However, it is unclear whether or not treatment of FAI and labral repair were coded as chondroplasty/abrasion arthroplasty before 2011.…”

Arthroscopy for Knee Osteoarthritis Has Not Decreased After a Clinical Trial

“…Our overall 2-year conversion to arthroplasty rate of less than 4% was much less than rates reported in other studies. Harris et al [8] reported a 2-year conversion rate greater than 20% in patients 65 years and older in Australia; however, the minimum age of patients in their study was older than that in our study and advanced age has been shown to be a risk factor for early conversion to arthroplasty [9,25]. Another study of patients in Ontario, Canada, showed a 1-year conversion rate of 9% and 3-year conversion rate of 18% among patients 50 and older [25].…”

“…Studies regarding the use of arthroscopic procedures for knee arthritis are inconsistent-some show decreasing use of arthroscopy with time [10,12,19], whereas another does not [1]. Some studies also show high rates of conversion from arthroscopy to arthroplasty within a short time, suggesting that the worst candidates for arthroscopy (ie, those with substantial enough degenerative changes to warrant knee arthroplasty) continue to be selected for the procedure [5,8,9,22,23]. Such findings raise concerns regarding the translation of evidence from major studies to real clinical practice.…”

Setting the research agenda for improving health care in musculoskeletal disorders

“…[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.…”