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

BMC Musculoskeletal Disorders

Bin B Jalaludin³  Rajat Mittal¹  Shanley Chong³  Justine M Naylor²  Navdeep S Madan¹  Ian A Harris² 

[1] South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia;Orthopaedic Department, Liverpool Hospital, Liverpool, NSW, Australia;Centre for Research, Evidence Management and Surveillance, Liverpool, NSW, Australia

关键词: Knee arthroplasty;    Knee arthroscopy;   

Others  :  1132736
DOI  :  10.1186/1471-2474-14-143

 received in 2012-10-05, accepted in 2013-04-19,  发布年份 2013

【 摘 要 】

Background

Knee 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.

Methods

We 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.

Results

There 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).

Conclusions

Rates 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.

【 授权许可】

   
2013 Harris et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Spahn M, Klinger M: How valid is the arthroscopic diagnosis of cartilage lesions? Results of an opinion survey among highly experienced arthroscopic surgeons. Arch Orthop Trauma Surg 2009, 129:1117-1121.
• [2]Simpson DA, Thomas NP, Aichroth PM: Open and closed meniscectomy: a comparative analysis. J Bone Joint Surg Br 1986, 68:301-304.
• [3]Sprague NF: Arthroscopic debridement for degenerative knee joint disease. Clin Orthop Relat Res 1981, 160:118-123.
• [4]Rand JA: Role of arthroscopy in osteoarthritis of the knee. Arthroscopy 1991, 7:358-363.
• [5]Baumgaertner MR, Cannon WD Jr, Vittori JM, Schmidt ES, Maurer RC: Arthroscopic debridement of the arthritic knee. Clin Orthop Relat Res 1990, 253:197-202.
• [6]McGinley BJ, Cushner FD, Scott WN: Debridement arthroscopy. 10-year follow up. Clin Orthop Relat Res 1999, 367:190-194.
• [7]Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C: Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev 2008., 1CD005118
• [8]Gibson JN, White MD, Chapman VM, Strachan RK: Arthroscopic lavage and debridement for osteoarthritis of the knee. J Bone Joint Surg Br 1992, 74:534-537.
• [9]David T, Gambardella R: Arthroscopic debridement of the arthritic knee: indications and results. Curr Opin Orthop 2000, 11:9-13.
• [10]Aicroth PM, Patel DV, Moyes ST: A prospective review of arthroscopic debridement for degenerative joint disease of the knee. Int Orthop 1999, 15:351-355.
• [11]Dervin GF, Stiell IG, Rody K, Grabowski J: Effect of arthroscopic debridement for osteoarthritis of the knee on health-related quality of life. J Bone Joint Surg Am 2003, 85:10-19.
• [12]Fond J, Rodin D, Ahmad S, Nirschl RP: Arthroscopic debridement for the treatment of osteoarthritis of the knee: 2- and 5-year results. Arthroscopy 2002, 18:829-834.
• [13]Moseley JB, O'Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP: A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New Engl J Med 2002, 347:81-88.
• [14]Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ, Feagan BG, Donner A, Griffin SH, D’Ascanio LM, Pope JE, Fowler PJ: A randomized trial of arthroscopic surgery for osteoarthritis of the knee. New Engl J Med 2009, 359:1097-1107.
• [15]Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S: Arthroscopic of conservative treatment of degenerative medial meniscus tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthosc 2007, 15:393-401.
• [16]Johanson NA, Kleinbart FA, Cerynik DL, Brey JM, Ong KL, Kurtz SM: Temporal relationship between knee arthroscopy and arthroplasty: a quality measure for joint care? J Arthroplasty 2011, 26:187-191.
• [17]Hawker G, Guan J, Judge A, Dieppe P: Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement. J Bone Joint Surg Am 2008, 90:2337-2345.
• [18]Raaijmaakers M, Vanlauwe J, Vandenneucker H, Dujardin J, Bellemans J: Arthroscopy of the knee in elderly patients: cartilage lesions and their influence on short term outcome. A retrospective followup of 183 patients. Acta Orthop Belg 2010, 76:79-85.
• [19]Wai EK, Kreder HJ, Williams JI: Arthroscopic debridement of the knee for osteoarthritis in patients fifty years of age or older: utilization and outcomes in the Province of Ontario. J Bone Joint Surg Am 2002, 84:17-22.
• [20]Dearing J, Brenkel I: Incidence of knee arthroscopy in patients over 60 years of age in Scotland. Surgeon 2010, 8:144-150.
• [21]McCullagh P, Nelder JA: Generalized linear models. 2nd edition. London: Chapman and Hall; 1989.
• [22]Kim S, Bosque J, Meehan JP, Jamali A, Marder R: Increase in outpatient knee arthroscopy in the United States: a comparison of national surveys of ambulatory surgery, 1996 and 2006. J Bone Joint Surg Am 2011, 93:994-1000.
• [23]Lingard EA, Berven S, Katz JN: Management and care of patients undergoing total knee arthroplasty: variations across different health care settings. Arthrit Care Res 2000, 13:129-136.
• [24]Australian Bureau of Statistics: NSW State and Regional Indicators 2008: Private Health Insurance Coverage NSW and ACT. Canberra: Australian Bureau of Statistics; 2009.
• [25]Australian Bureau of Statistics: NSW State and Regional Indicators 2010: Private Health Insurance Coverage NSW and ACT. Canberra: Australian Bureau of Statistics; 2010.
• [26]Potts A, Harrast JJ, Harner CD, Miniaci A, Jones MH: Practice patterns for arthroscopy of osteoarthritis of the knee in the United States. Am J Sports Med 2012, 40:1247-1251.
• [27]Bohensky MA, Sundarajan V, Andrianopoulos N, de Steiger RN, Bucknill A, Kondogiannis CM, McColl G, Brand CA: Trends in elective knee arthroscopies in a population-based cohort, 2000–2009. Med J Aust 2012, 197:399-403.