Abstract
BackgroundArthroscopic surgery is a common treatment for knee osteoarthritis (OA), particularly for symptomatic meniscal tear. Many patients with knee OA who have arthroscopies go on to have total knee arthroplasty (TKA). Several individual studies have investigated the interval between knee arthroscopy and TKA. Our objective was to summarize published literature on the risk of TKA following knee arthroscopy, the duration between arthroscopy and TKA, and risk factors for TKA following knee arthroscopy.MethodsWe searched PubMed, Embase, and Web of Science for English language manuscripts reporting TKA following arthroscopy for knee OA. We identified 511 manuscripts, of which 20 met the inclusion criteria and were used for analysis. We compared the cumulative incidence of TKA following arthroscopy in each study arm, stratifying by type of data source (registry vs. clinical), and whether the study was limited to older patients (≥ 50) or those with more severe radiographic OA. We estimated cumulative incidence of TKA following arthroscopy by dividing the number of TKAs among persons who underwent arthroscopy by the number of persons who underwent arthroscopy. Annual incidence was calculated by dividing cumulative incidence by the mean years of follow-up.ResultsOverall, the annual incidence of TKA after arthroscopic surgery for OA was 2.46% (95% CI 1.68–3.25%). We calculated the annual incidence of TKA following arthroscopy in four separate groups defined by data source (registry vs. clinical cohort) and whether the sample was selected for disease progression (either age or OA severity). In unselected registry studies the annual TKA incidence was 1.99% (95% CI 1.03–2.96%), compared to 3.89% (95% CI 0.69–7.09%) in registry studies of older patients. In unselected clinical cohorts the annual incidence was 2.02% (95% CI 0.67–3.36%), while in clinical cohorts with more severe OA the annual incidence was 3.36% (95% CI 1.38–5.34%). The mean and median duration between arthroscopy and TKA (years) were 3.4 and 2.0 years.ConclusionsClinicians and patients considering knee arthroscopy should discuss the likelihood of subsequent TKA as they weigh risks and benefits of surgery. Patients who are older or have more severe OA are at particularly high risk of TKA.
Highlights
Arthroscopic surgery is a common treatment for knee osteoarthritis (OA), for symptomatic meniscal tear
Categorization of studies We examined the cumulative incidence of total knee arthroplasty (TKA) following knee arthroscopy in specific patient subgroups
Thirty-five of the manuscripts were excluded from our analysis: 11 were not written in English, 2 did not report on arthroscopic procedures before TKA, 3 did not report on TKA, and 19 were excluded for other reasons, such as mixed cohort (e.g., OA and post-traumatic arthritis), secondary sources, or insufficient data on methodology
Summary
Arthroscopic surgery is a common treatment for knee osteoarthritis (OA), for symptomatic meniscal tear. Osteoarthritis (OA) is a debilitating disease, affecting over 40 million people in the United States [1, 2]. Of those affected, approximately 14 million have symptomatic knee OA [3], which presents with pain, loss of knee joint function, and loss of valued activities. Moseley et al showed that sham surgery and arthroscopic surgery for OA had similar pain relief and functional improvement up to 2 years post-surgery [7]. Kirkley and colleagues showed that arthroscopy and a conservative exercise regimen had similar symptomatic and functional outcomes in persons with knee OA [8]. Arthroscopic surgery is felt to be ineffective for OA per se, while the effectiveness of APM in persons with MT and concomitant OA is debated [14]
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