Knee Arthroscopy Patients Research Articles

Analgesic effects of intraarticular anaesthetic lidocaine and methylprednisolone versus methylprednisolone alone following knee arthroscopy.

Knee arthroscopy is a widely practiced orthopaedic procedure known for its minimally invasive approach, allowing quicker recovery times and less postoperative discomfort than traditional open surgeries. However, managing postoperative pain remains a critical aspect of patient care and satisfaction. The main objective of this research is to examine the relationships between patient demographics (age, gender, BMI) and early postoperative outcomes, including pain, physiotherapy, and walking. Randomized data collection, clinical trial study of 2 groups of patients. The patients were split into lidocaine 1 % 16 ml + methylprednisolone 160 mg 4 ml) and (methylprednisolone only 160 mg 4 ml) groups. All patients in both groups were queried about age, gender, BMI, and pain on the first, third, and 15th days following surgery. All patients were tested for physiotherapy on the second, third, and fourth postop days. After surgery, walking was tested on the third, fourth, and fifth days. Significant differences in postoperative pain relief and physiotherapy initiation times were observed. There are notable associations between treatment groups and recovery metrics, such as pain levels and mobility on various days' post-surgery. Significant demographic influences (age, gender, BMI) on recovery outcomes are observed, particularly in walking and pain at day 15 post-operation. lidocaine and methylprednisolone improve postoperative pain relief and functional recovery in knee arthroscopy patients, with most experiencing reduced pain early post-surgery (early physiotherapy) and an expedited return to walking (decreased morbidity). Patients taking just methylprednisolone recovered slower. Age, gender, and BMI affected pain and walking abilities post-operation but not physiotherapy time, underscoring the personalised approach needed in postoperative treatment.

Use of therapeutic laser vs TENS currents for painmanagement in postoperative knee arthroscopy patients inthe postoperative stage

Objective: To measure pain in postoperative knee arthroscopy patients after undergoing treatment with therapeutic laser vs. TENS currents. Materials and method: An experimental, longitudinal, prospective, and comparative study was carried out that included 14 patients who attended the Physical Medicine and Rehabilitation area of the Hospital Central Militar, identifie with the diagnosis of postoperative knee arthroscopy, through randomization. simple, by lottery, to include patients in the work groups: treatment with therapeutic laser vs treatment with TENS currents. The visual analogue scale was applied in the evaluation, and measurement of both knees was carried out by circometry, pre- and post-treatment to measure edema. The analysis was carried out with the statistical program SPSS version 26 and the student’s T test was used. Significance level p<0.05. Results: A total of 14 patients entered the study, 7 were treated with therapeutic laser and 7 with TENS currents. 50% (7 patients) were women and 50% (7 patients) were men. The average age was 44.85 years. When analyzing the visual analog scale, in the pre- and post-treatment evaluation, both groups decreased their pain intensity with statistically significan differences (with a standard deviation of 1.15 for TENS and a standard deviation of 1.35). When comparing both results, a difference was observed. statistically significant difference in favor of TENS Currents over therapeutic laser p<0.0001. Conclusions: In both treatments, both the therapeutic laser and the TENS currents, improvements were observed in the pain perceived by the patients. Having a greater reduction in pain with TENS currents. Therefore, in this study we conclude that treatment with TENS currents is more effective than therapeutic laser in pain management in post-knee arthroscopy patients. No improvement in edema was observed in any of the treatments.

Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: An epidemiologic study.

The objective of this study was to determine the reduction in prescribed opioid pain dosage units to pediatric patients experiencing acute pain and to assess patient satisfaction with pain control 90-day post discharge following the 2017 Ohio opioid prescribing cap law. The retrospective chart review included 960 pediatric (age 0-18 years) burn injury and knee arthroscopy patients treated between August 1, 2015-August 31, 2019. Prospectively, legal guardians completed a survey for a convenience sample of 50 patients. Opioid medications (days and morphine milligram equivalents (MMEs)/kg) prescribed at discharge before and after the Ohio law implementation were collected. Guardians reported experience and satisfaction with their child's opioid prescription at 90-days post discharge. From pre-law to post-law, there was a significant decrease (p<0.001) within the burn and knee cohorts in the median days (1.7 to 1.0 and 5.0 to 3.8, respectively) and median total MMEs prescribed (15.0 to 2.5 and 150.0 to 90.0, respectively). An interrupted time series analysis revealed a statistically significant decrease in MMEs/kg and days prescribed at discharge when the 2017 Ohio opioid prescription law went into effect, with an abrupt level change. Prospectively, more than half of participants were satisfied (72% burn and 68% knee) with their pain control and felt they received the right amount of medication (84% burn and 56% knee). Inpatient opioid use was not changed pre- and post-law. Discharge opioids prescribed for pediatric burn and knee arthroscopy procedures has decreased from 2015-2019. Caregivers varied greatly in their satisfaction with pain control and the amount of opioid prescribed.

Evaluation of the effect of preoperative use of pregabalin on pain in patients with metabolic syndrome during knee arthroscopy

nee arthroscopy is a common surgical procedure often accompanied by significant postoperative pain syndrome. As pain limits patient mobility and prolongs patients’ hospitalization, the development of optimal pain management with minimal side effects for early activation and full recovery of patients is urgent.&#x0D; Objective — to assess the impact of preoperative administration of pregabalin on postoperative pain syndrome in patients with metabolic syndrome after arthroscopic knee surgery.&#x0D; Materials and methods. A double‑blind, placebo‑controlled study was conducted, involving 50 patients admitted to the Orthopedic Department of the State Scientific Institution «Center for Innovative Medical Technologies of the National Academy of Sciences of Ukraine» between the years 2020 and 2023. Patients, scheduled for knee arthroscopy, were randomly divided into two equal groups, receiving placebo or pregabalin at a dose of 300 mg 2 hours before surgery, the drug was administered orally 12 hours later.&#x0D; Results. The results demonstrated a reduction in static pain intensity within 24 hours and a decrease in dynamic pain intensity after 48 hours among patients who received pregabalin before the surgery. Pregabalin administration prior to knee arthroscopy in patients with metabolic syndrome was associated with lower opioid consumption at 24 hours.&#x0D; Conclusions. The effectiveness of the preoperative pregabalin administration in reducing the postoperative pain syndrome in patients who underwent arthroscopic surgery on the knee joint has been established. However, further research is warranted to determine the optimal dosage and timing of pregabalin administration for this specific patient population.&#x0D;

Metabolic phenotypes reflect patient sex and injury status: A cross-sectional analysis of human synovial fluid

Osteoarthritis is a heterogeneous disease. The objective was to compare differences in underlying cellular mechanisms and endogenous repair pathways between synovial fluid (SF) from male and female participants with different injuries to improve the current understanding of the pathophysiology of downstream post-traumatic osteoarthritis (PTOA). SF from n=33 knee arthroscopy patients between 18 and 70 years with no prior knee injuries was obtained pre-procedure and injury pathology assigned post-procedure. SF was extracted and analyzed via liquid chromatography-mass spectrometry metabolomic profiling to examine differences in metabolism between injury pathologies (ligament, meniscal, and combined ligament and meniscal) and patient sex. Samples were pooled and underwent secondary fragmentation to identify metabolites. Different knee injuries uniquely altered SF metabolites and downstream pathways including amino acid, lipid, and inflammatory-associated metabolic pathways. Notably, sexual dimorphic metabolic phenotypes were examined between males and females and within injury pathology. Cervonyl carnitine and other identified metabolites differed in concentrations between sexes. These results suggest that different injuries and patient sex are associated with distinct metabolic phenotypes. Considering these phenotypic associations, a greater understanding of metabolic mechanisms associated with specific injuries, sex, and PTOA development may yield data regarding how endogenous repair pathways differ between male and female injury types. Ongoing metabolomic analysis of SF in injured male and female patients can be performed to monitor PTOA development and progression.

Total Knee Conversion Rates and Functional Outcome After Calcium Phosphate Injection for Bone Marrow Lesions of the Knee.

Untreated osteoarthritis (OA)-related bone marrow lesions (OA-BML) can hasten the progression of knee OA. Previous studies have shown that fluoroscopically guided intraosseous calcium-phosphate (CaP) injections of OA-BML during knee arthroscopy can lead to pain reduction, improved functionality, and prolonged time until conversion to total knee arthroplasty (TKA). The purpose of this retrospective study is to compare the clinical outcomes of patients who underwent knee arthroscopy and CaP injection for OA-BML versus knee arthroscopy for non-OA-BML pathologies. Two-year follow-up data and patient-reported outcomes including knee injury and operative outcome scores, joint replacement scores (KOOS, JR) were available for 53 patients in the CaP group and 30 patients in the knee arthroscopy group. Results indicate that patients in the CaP group had less frequent conversion to TKA compared with patients in the knee arthroscopy group. Statistical analysis demonstrated a statistical difference between preoperative and postoperative KOOS, JR within the CaP group but not for the knee arthroscopy group. Two-year postoperative KOOS, JR for CaP patients was statistically greater than the 2-year postoperative KOOS, JR of knee arthroscopy patients. Results indicate greater improvement in functional outcomes with knee arthroscopy and CaP injection of OA-BML compared with knee arthroscopy alone for non-OA-BML diagnoses. The results of this retrospective study help to distinguish the benefits of knee arthroscopy accompanied by CaP intraosseous injection from that of knee arthroscopy alone.

Frequency and structure of arthroscopy complications in patients with knee joint osteoarthritis

BACKGROUND: Arthroscopy is one of the most popular techniques in traumatology and orthopedic practice. The development of the criteria for selection of patients and indications for knee arthroscopy should be carried out for the improvement of arthroscopic technology. It is important to develop safe and informative surgical access to intra-articular structures, optimize stages and techniques, minimize the complications of arthroscopic surgery.&#x0D; AIM: The publications describing results of knee arthroscopy in patients with knee osteoarthritis have been analyzed in the study.&#x0D; MATERIALS AND METHODS: A systematic literature review has been conducted by searching in the Pub-Med/MEDLINE database and eLibrary. The search depth was 20 years; a keyword searching has been performed (including the keywords complications, indications/contraindications for arthroscopy). Possible relevant peri-, intra- and postoperative complications of knee arthroscopy are discussed.&#x0D; RESULTS: Knee joint arthroscopy is the treatment of choice for trauma, injury and orthopedic disease. However, arthroscopy of the knee joint does not always bring a positive effect. The number of negative consequences of this surgical intervention, according to the statistics, range from 0.1 to 2.6% of all cases of knee joint arthroscopy. Complications can be local and systemic and develop both in the early postoperative and in the long-term period after the operation. The review is devoted to the analysis of the data concerning the frequency and structure of knee arthroscopy complications in patients with osteoarthritis of knee joints.&#x0D; CONCLUSIONS: Intra- and postoperative complications of arthroscopic surgery of the knee joint include nerve and vascular lesions, port disposition, thrombosis, pulmonary embolism, instrument breakage, and compartment syndrome associated with a defect in the joint capsule and leakage of irrigation fluid. In the postoperative period, complications such as hemarthrosis, thrombosis, pulmonary embolism, infection and synovial fistulas are possible. Complications of the late postoperative period of arthroscopic interventions are arthrofibrosis, Ahlbacks disease or aseptic osteonecrosis of the femur or tibia, as well as complex regional pain syndrome.

Targeted proteomics for evaluating risk of venous thrombosis following traumatic lower‐leg injury or knee arthroscopy

IntroductionPatients with lower‐leg cast immobilization and patients undergoing knee arthroscopy have an increased risk of venous thrombosis (VT). Guidelines are ambiguous about thromboprophylaxis use, and individual risk factors for developing VT are often ignored. To assist in VT risk stratification and guide thromboprophylaxis use, various prediction models have been developed. These models depend largely on clinical factors and provide reasonably good C‐statistics of around 70%. We explored using protein levels in blood plasma measured by multiplexed quantitative targeted proteomics to predict VT. Our aim was to assess whether a VT risk prediction model based on absolute plasma protein quantification is possible. MethodsWe used internal standards to quantify proteins in less than 10 μl plasma. We measured 270 proteins in samples from patients scheduled for knee arthroscopy or with lower‐leg cast immobilization. The two prospective POT‐(K)CAST trails allow complementary views of VT signature in blood, namely pre and post trauma, respectively. From approximately 3000 patients, 31 patients developed VT who were included and matched with double the number of controls. ResultsTop discriminating proteins between cases and controls included APOC3, APOC4, APOC2, ATRN, F13B, and F2 in knee arthroscopy patients and APOE, SERPINF2, B2M, F13B, AFM, and C1QC in patients with lower‐leg cast. A logistic regression model with cross‐validation resulted in C‐statistics of 88.1% (95% CI: 85.7–90.6%) and 79.6% (95% CI: 77.2–82.0%) for knee arthroscopy and cast immobilization groups respectively. ConclusionsPromising C‐statistics merit further exploration of the value of proteomic tests for predicting VT risk upon additional validation.

Total Knee Arthroplasty following Knee Arthroscopy in Patients over 50.

The purpose of this study was to evaluate the conversion rate of knee arthroscopy to ipsilateral total knee arthroplasty (TKA) within 2 years in patients aged 50 or older at the time of arthroscopy. The administrative database from a large, physician-owned orthopaedic practice (>100 surgeons) was queried to identify patients over the age of 50 who had undergone arthroscopic knee surgery between January 1, 2006 and January 2, 2015. The subset of patients who converted to TKA within 2 years after knee arthroscopy was identified and matched by age and sex to a control population that did not convert to TKA. Rates of conversion to TKA were calculated. Prearthroscopic digital radiographs were reviewed and Kellgren-Lawrence (KL) grades were compared among case and control populations. Univariable analyses and multivariable regression analysis were performed. Eight hundred seven of 16,061 (5.02%) patients aged 50 or older were converted to TKA within 2 years following ipsilateral knee arthroscopy. In univariable analysis, the rate of conversion to TKA in patients aged between 50 and 54 was 2.94%, compared with 4.44% in patients aged between 55 and 64, and 8.32% in patients 65 or older (p < 0.0001). Female sex was associated with a higher rate of conversion to TKA in univariable analysis (5.93 vs. 4.02% in males, p < 0.0001). KL grades were higher among patients who converted to TKA compared with those who did not (p < 0.0001). In a multivariable regression model controlling for age, sex, and KL grade, only increased KL grade was associated with increased odds of conversion to TKA. In the appropriately selected older patient, the risk of conversion to TKA within 2 years of knee arthroscopy is low (∼5%). Patients with KL grade 2 or higher at the time of arthroscopy should be counseled on the increased odds of early conversion to TKA.

Effect of acupoint application of Zhanjin Huoxue formula combined with local cold compress on swelling and pain after knee arthroscopy in patients with knee osteoarthritis

To compare the effect between acupoint application of Zhanjin Huoxue formula combined with local cold compress and simple local cold compress on swelling and pain after knee arthroscopy in patients with knee osteoarthritis (KOA). A total of 62 KOA patients with knee swelling after knee arthroscopy were randomly divided into an observation group and a control group, 31 cases in each group. In the control group, cold compress was adopted after surgery, 3 times a day. On the basis of the treatment as the control group, acupoint application of Zhanjin Huoxue formula (angelicae sinensis radix, chuanxiong rhizome, cinnamon twig, poria, etc.) was applied at Liangqiu (ST 34), Xuehai (SP 10), Zusanli (ST 36), Fenglong (ST 40), Sanyinjiao (SP 6), Yinlingquan (SP 9), Yanglingquan (GB 34), Xuanzhong (GB 39) on the affected side in the observation group, 4 h each time, 2 times a day. The treatment was given 7 days in both groups. Before treatment and 1,3,5 and 7 days into treatment, the pain visual analogue scale (VAS) score and swelling value of knee joint (2 cm above the patella upper pole, patella midline, 5 cm below the patella lower pole) were compared in the two groups. The VAS scores 3, 5 and 7 days into treatment were lower than those before treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The swelling values of 2 cm above the patella upper pole 3, 5 and 7 days into treatment were lower those before treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The swelling values of patella midline 1, 3, 5 and 7 days into treatment were lower than those before treatment in the two groups (P<0.05), and except for 1 day into treatment, those in the observation group were lower than the control group (P<0.05). The swelling values of 5 cm below the patella lower pole 1 day into treatment in the observation group and 3, 5 and 7 days into treatment in the two groups were lower those before treatment (P<0.05), and except for 1 day into treatment, those in the observation group were lower than the control group (P<0.05). The total effective rate in the observation group was 93.5% (29/31), which was higher than 74.2% (23/31) in the control group (P<0.05). Acupoint application of Zhanjin Huoxue formula combined with cold compress could effectively improve the knee joint swelling and pain after arthroscopy in KOA patients, and the curative effect is better than simple cold compress.

Risk of Infection in Knee Arthroscopy Patients Undergoing Corticosteroid Injections in the Perioperative Period.

Background:Recent evidence suggests that there may be an increased risk of infection for patients undergoing a corticosteroid injection before, during, or after knee arthroscopy.Purpose:To systematically review the literature to evaluate the risk of postoperative infection in patients undergoing intra-articular corticosteroid injections (CSI) before, during, or after knee arthroscopy.Study Design:Systematic review; Level of evidence, 3.Methods:A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases to identify studies that evaluated the rate of postoperative infection in patients undergoing knee arthroscopy who received an intra-articular CSI during the perioperative period. The search phrase used was “knee AND arthroscopy AND injection AND (infection OR revision).” A subanalysis was also performed to analyze infection rates based on the timing of the corticosteroid injection in relation to arthroscopy.Results:Four studies met the inclusion criteria, representing 11,925 patients undergoing knee arthroscopy with an intra-articular CSI administered during the perioperative period (mean follow-up, 5.3 months) and 247,329 patients without a corticosteroid injection during the perioperative period (mean follow-up, 5.9 months). Patients who received an injection experienced a statistically significantly higher rate of postoperative infection (2.2%) when compared with patients who did not receive an injection (1.1%; P < .001). When analyzed by the timing of the injection, patients receiving an injection preoperatively or intraoperatively experienced a statistically significantly higher rate of postoperative infection (3% and 2.6%, respectively) when compared with patients receiving an injection postoperatively (1.4%; P = .001 for both).Conclusion:Patients undergoing knee arthroscopy who receive an intra-articular CSI during the perioperative period can be expected to experience significantly higher postoperative infection rates when compared with patients not receiving an injection. Furthermore, patients receiving a corticosteroid injection pre- or intraoperatively may experience significantly higher rates of postoperative infection when compared with patients receiving an injection postoperatively.

Knee arthroscopy in patients over 64 years suffering from primary gonarthrosis

Objectives:to evaluate the results of the arthroscopic surgical techniques in patients with primary gonarthrosis older than 64 years.Methods:an analytical observational study was carried out in 40 patients older than 64 years treated arthroscopically with the diagnosis of primary gonarthrosis, at the Manuel Ascunce Domenech University Hospital in the city of Camagüey from October 2012 to May 2019. The research has a level of evidence IV recommendation D.Results:the average age of the 40 patients studied was 69,6 years, with a predominance of female to male, with a ratio of 3 to 1. Tricompartmental disease predominated in most patients as well as grade IV according to the Outerbridge RE classification. The cartilage and associated meniscus injuries predominate. Grades III and IV of the Kellgram JH and Lawrence JS classification were the most found. The most commonly used arthroscopic treatments were debridement and partial meniscectomy. Statistical significance between a before and after was detected.Conclusion:the results of the investigation show that the procedures performed through the arthroscopic route for patients with primary gonarthrosis over 64 years of age are effective in more than half of the patients.

Bilateral pulmonary embolism without deep venous thrombosis was observed after knee arthroscopy: a case report

BackgroundSymptomatic pulmonary embolism (PE) after knee arthroscopy is extremely rare. If the embolism is not treated promptly, the patient may die. Bilateral pulmonary embolism with associated pulmonary infarct without concomitant deep vein thrombosis has never been reported following routine knee arthroscopy.Case presentationA 50-year-old female patient with no other risk factors other than hypertension, obesity, varicose veins in the ipsilateral lower extremities and elevated triglyceride (TG) presented to our ward. She had experienced sudden chest tightness, polypnea and fainting after going to the bathroom the morning of the second postoperative day and received emergency medical attention. Colour ultrasonography of the extremities showed no deep vein thrombosis. Lung computed tomography angiography (CTA) showed multiple embolisms scattered in both pulmonary artery branches. Thus, emergency interventional thrombolysis therapy was performed, followed by postoperative symptomatic treatment with drugs with thrombolytic, anticoagulant and protective activities. One week later, lung CTA showed a significant improvement in the PEs compared with those in the previous examination. Since the aetiology of PE and no obvious symptoms were discerned, the patient was discharged.ConclusionAlthough knee arthroscopy is a minimally invasive and quick procedure, the risk factors for PE in the perioperative period should be considered and fully evaluated to enhance PE detection. Moreover, a timely diagnosis and effective treatment are important measures to prevent and cure PE after knee arthroscopy. Finally, clear guidelines regarding VTE thromboprophylaxis following knee arthroscopy in patients with a low risk of VTE development are needed.

Indications for Knee Arthroscopy in Patients with Osteoarthritis: Commentary on an article by Alex Gu, MD, et al.: "Comparison of Revision Risk Based on Timing of Knee Arthroscopy Prior to Total Knee Arthroplasty".

Indications for Knee Arthroscopy in Patients with Osteoarthritis: Commentary on an article by Alex Gu, MD, et al.: "Comparison of Revision Risk Based on Timing of Knee Arthroscopy Prior to Total Knee Arthroplasty".

Previous History of Knee Arthroscopy in Patients Undergoing Total Knee Arthroplasty: An Examination of the Effect of the Literature and American Academy of Orthopaedic Surgeons 2013 Arthroscopy Guidelines on Clinical Practice

PurposeTo compare the rate of previous knee arthroscopy in patients undergoing total knee arthroplasty (TKA) before (2005-2006) and after (2018) publication of landmark studies that examined the effectiveness of knee arthroscopy as well as the American Academy of Orthopaedic Surgeons 2013 knee arthroscopy guidelines.MethodsWe performed a retrospective chart review of 214 patients who underwent a TKA between 2005 and 2006 (Group 1) and 213 patients who underwent a TKA in 2018 (Group 2). We reviewed medical records to determine whether previous knee arthroscopy was performed. Group comparisons were made using the t test for continuous data and the χ2 test for categorical data, and means ± standard deviation are presented.ResultsPatients in Group 2 were older than those in Group 1 (67.0 ± 8.3 vs 64.3 ± 11.5 years, P = .01); however, there were no differences between groups with respect to sex (P = .40), body mass index (P = .36), and laterality of TKA (P = .05). There was no difference in the history of previous knee arthroscopy between Groups 1 and 2 overall (27% vs 32%, P = .27) and within 10 years of TKA (17% vs 15%, P = .44).ConclusionsWe did not find a difference in the number of previous knee arthroscopies for patients undergoing TKA in 2018 versus 2005-2006. This suggests that the recommendations set forth by landmark clinical trials that examined the effectiveness of knee arthroscopy and the AAOS 2013 knee arthroscopy guidelines did not have a sudden impact within our geographic region, but there is some evidence to suggest a gradual shift in treatment, where knee arthroscopy is withheld near imminent knee arthroplasty.Level of EvidenceIII, retrospective comparative study.

Temporal trends in knee arthroscopy surgery in Ontario, Canada, from 2004 to 2018: the influence of new evidence on changes in practice

Temporal trends in knee arthroscopy surgery in Ontario, Canada, from 2004 to 2018: the influence of new evidence on changes in practice

Prior Knee Arthroscopy Increases the Failure Rate of Subsequent Unicompartmental Knee Arthroplasty

BackgroundIn selected patients, knee arthroscopy is performed prior to unicompartmental knee arthroplasty (UKA) to treat symptomatic mechanical pathology, delay arthroplasty, and assess the knee compartments. The purpose of this study was to determine if knee arthroscopy prior to UKA is associated with increased rates of UKA failure or conversion to total knee arthroplasty (TKA). MethodsData was collected from the Humana insurance database from 2007-2017. Patients who underwent knee arthroscopy within two years prior to UKA were identified and matched with controls based on age, gender, Charlson Comorbidity Index, smoking status, and obesity. Rates of conversion to TKA and failure for various causes were compared between cohorts. ResultsPrior to propensity matching, 8353 UKA patients met inclusion criteria. Of these, 1079 patients (12.9%) underwent knee arthroscopy within two years of UKA and were matched to 1079 patients (controls) who did not undergo knee arthroscopy in the two years preceding UKA. No differences in demographics/comorbidities existed among cohorts. Compared to controls, the knee arthroscopy cohort was more likely to experience failure for aseptic loosening (2.4% vs 1.1%; OR 2.166; P = .044) and significantly more likely to require conversion to TKA (10.4% vs 4.9%; OR 2.113; P < .001) within two years of UKA. ConclusionKnee arthroscopy within two years of UKA is associated with an increased rate of UKA conversion to TKA and a higher rate of UKA failure from aseptic loosening. Although clinicians should be mindful of this association when performing knee arthroscopy in patients who may be indicated for future UKA, further research is needed to better characterize these findings.

Risk Factors for Early Total Knee Replacement after Ipsilateral Knee Arthroscopy in Patients over 55 Years of Age

Arthroscopic knee surgery (AKS) is often not successful in elderly patients with osteoarthritis and degenerative meniscus tears. Many patients require subsequent total knee replacement (TKR). We performed a case-control study to identify risk factors for early TKR following AKS in patients over 55. Data were collected on patients in an integrated healthcare system who underwent AKS between January 2010 and December 2012, and then had ipsilateral total knee replacement (TKR) within one year. Controls were matched from patients who did not have TKR within one year. Of the 7,301 AKS patients, 453 (6.2%) went on to TKR. We matched 390 cases with controls (780 total subjects); 186 subjects were excluded due to inadequate radiographs or medical records resulting in a cohort of 594 patients. Statistical analysis showed that a Kellgren-Lawrence score of 3 or 4 (OR 1.9 CI 1.3-2.8, p < 0.01), age greater than 65 (OR 2.2, CI 1.5-3.2, p < 0.01), contralateral TKR (OR 2.3, CI 1.1-5.0, p < 0.04) were associated with a higher likelihood of early TKR. Sex, race, diagnosis of diabetes, prior ipsilateral knee surgery, and prior contralateral knee surgery were not associated with early TKR. When considering AKS for older patients with degenerative arthritis and meniscus tears, care providers should consider the risk of early TKR. Older patients with advanced arthritis and a diagnosis of osteoarthritis, or combined with a meniscus tear, are especially at risk for early TKR.

Risk Factors for Early Total Knee Replacement after Ipsilateral Knee Arthroscopy in Patients over 55 Years of Age

Arthroscopic knee surgery (AKS) is often not successful in elderly patients with osteoarthritis and degenerative meniscus tears. Many patients require subsequent total knee replacement (TKR). We performed a case-control study to identify risk factors for early TKR following AKS in patients over 55. Data were collected on patients in an integrated healthcare system who underwent AKS between January 2010 and December 2012, and then had ipsilateral total knee replacement (TKR) within one year. Controls were matched from patients who did not have TKR within one year. Of the 7,301 AKS patients, 453 (6.2%) went on to TKR. We matched 390 cases with controls (780 total subjects); 186 subjects were excluded due to inadequate radiographs or medical records resulting in a cohort of 594 patients. Statistical analysis showed that a Kellgren-Lawrence score of 3 or 4 (OR 1.9 CI 1.3-2.8, p &lt; 0.01), age greater than 65 (OR 2.2, CI 1.5-3.2, p &lt; 0.01), contralateral TKR (OR 2.3, CI 1.1-5.0, p &lt; 0.04) were associated with a higher likelihood of early TKR. Sex, race, diagnosis of diabetes, prior ipsilateral knee surgery, and prior contralateral knee surgery were not associated with early TKR. When considering AKS for older patients with degenerative arthritis and meniscus tears, care providers should consider the risk of early TKR. Older patients with advanced arthritis and a diagnosis of osteoarthritis, or combined with a meniscus tear, are especially at risk for early TKR.

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

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.