Impact of a national guideline on use of knee arthroscopy: An interrupted time-series analysis.

Ali Kiadaliri,Martin Englund,Dan Bergkvist,Leif E Dahlberg

doi:10.1093/intqhc/mzz089

Ali Kiadaliri, Martin Englund + Show 2 more

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https://doi.org/10.1093/intqhc/mzz089

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Abstract

ObjectiveTo assess the impact of the Swedish health authority recommendation against the use of knee arthroscopy in patients aged ≥40 years with knee osteoarthritis (OA).DesignInterrupted time series analysis.SettingPublic health care in Skåne region.ParticipantsPatients aged ≥40 years who underwent knee arthroscopy from January 2010 to December 2015.Intervention(s)National guideline’s recommendation against the use of knee arthroscopy in patients with knee OA.Main Outcome Measure(s)1) proportion of patients aged ≥40 years with a main diagnosis of Knee OA and/or degenerative meniscal lesions (DML) who underwent knee arthroscopy, and 2) overall knee arthroscopy rate per 100,000 Skåne population aged ≥40 years.ResultsA total of 6,155 knee arthroscopy were performed among people aged ≥40 years during study period. Of 42,044 patients with Knee OA/DML, 3,728 had knee arthroscopy. The recommendation was associated with reductions in the use of knee arthroscopy and two years after the recommendation, there was a reduction of 28.6% (95% CI: 9.3, 47.8) and 34.7% (23.9, 45.4) in proportion of Knee OA/DML patients with knee arthroscopy and the overall knee arthroscopy rate, respectively, relative to that expected if pre-recommendation trend continued. Our sensitivity analysis showed that the use of total knee replacement was stable over the study period.ConclusionThe national recommendation was associated with reduction in use of knee arthroscopy in public health care in southern Sweden. However, still 4.5% of these patients underwent knee arthroscopy in 2015 implying that more efforts are required to achieve the recommended target.

Highlights

Knee arthroscopy is a commonly performed orthopaedic procedure in management of degenerative knee disease including degenerative meniscal lesions [1]
The proportion of patients with knee OA/degenerative meniscal lesion who underwent knee arthroscopy declined from 9.3% in pre-recommendation to 6.5% in post-recommendation period
The segmented regression analysis suggested that, after adjustment for seasonality, while there was no immediate change in proportion of knee OA/degenerative meniscal lesion patients with knee arthroscopy, it declined by 0.14% bimonthly after the recommendation

Summary

Introduction

Knee arthroscopy is a commonly performed orthopaedic procedure in management of degenerative knee disease including degenerative meniscal lesions [1]. Degenerative meniscal lesions are increasingly regarded as an early sign of knee osteoarthritis (OA) with no direct effect on pain [2] and there has been accumulating evidence suggesting no additional benefits of knee arthroscopy in these patients above placebo or non-surgical management over the last decade [3,4,5,6,7,8,9]. Based on available evidence at the time, the guideline concluded that knee arthroscopy in OA does not have a better effect on pain, function and quality of life than placebo treatment and recommended against the use of knee arthroscopy in patients with knee OA [12].

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