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Determinants of knee replacement in subjects with a history of arthroscopy: data from the osteoarthritis initiative.

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Journal European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
Year 2016
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To investigate the risk and determinants of knee replacement (KR) in subjects with or at risk of osteoarthritis (OA) and a history of arthroscopy. METHODS: Data from the osteoarthritis initiative cohort were analyzed (n = 4796, up to the seventh year of follow-up). Cox proportional hazard analysis was used to determine the risk of KR according to the history of arthroscopy. A multivariable model was used to determine the risk factors for KR among subjects with a history of arthroscopy (n = 842), including age, gender, body mass index, history of knee injury, and baseline physical activity scale for the elderly, Western Ontario and McMaster (WOMAC) total score, and radiographic Kellgren and Lawrence (KL) score. RESULTS: History of arthroscopy was associated with risk of KR after adjustments for the mentioned determinants of OA (HR: 1.90 (1.49-2.44); P value <0.001). Female gender (HR: 1.86 (1.30-2.68); P value <0.001), higher WOMAC (HR: 1.02 (1.01-1.03); P value <0.001), and KL score (HR: 2.64 (2.08-3.35); P value <0.001) increased the risk of KR among subjects with a history of arthroscopy. Subjects with a history of knee injury had 50 % lower risk of KR (HR: 0.50 (0.35-0.72); P value <0.001) after arthroscopy. CONCLUSION: Female gender, more clinical symptoms and radiographic signs of OA, was associated with higher risk of future KR in subjects with a history of arthroscopy. Subjects with arthroscopy in the setting of concomitant knee injury were 50 % less likely to undergo KR compared to subjects who underwent arthroscopy without a history of concomitant knee injury.

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Arthroscopy for Knee Osteoarthritis Has Not Decreased After a Clinical Trial.

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Journal Clinical orthopaedics and related research
Year 2016
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Multiple clinical trials have shown that arthroscopy for knee osteoarthritis is not efficacious. It is unclear how these studies have affected orthopaedic practice in the USA. QUESTIONS/PURPOSES: We questioned whether, in the Veterans Health Administration system, rates of knee arthroscopy in patients with osteoarthritis have changed after publication of the initial clinical trial by Moseley et al. in 2002, and whether rates of arthroplasty within 2 years of arthroscopy have changed during the same period. METHODS: Patients 50 years and older with knee osteoarthritis who underwent arthroscopy between 1998 and 2010 were retrospectively identified and an annual arthroscopy rate was calculated from 1998 through 2002 and from 2006 through 2010. Patients who underwent knee arthroplasty within 2 years of arthroscopy during each period were identified, and a 2-year conversion to arthroplasty rate was calculated. RESULTS: Between 1998 and 2002, the annual arthroscopy rate decreased from 4% to 3%. Of these arthroscopies, 4% were converted to arthroplasty within 2 years. Between 2006 and 2010, the annual arthroscopy rate increased from 3% to 4%. Of these arthroscopies, 5% were converted to arthroplasty within 2 years. CONCLUSIONS: Rates of arthroscopy in patients with knee osteoarthritis and conversion to arthroplasty within 2 years have not decreased with time. It may be that evidence alone is not sufficient to alter practice patterns or that arthroscopy rates for arthritis for patients in the Veterans Health Administration system were already so low that the results of the initial clinical trial had no substantial effect. LEVEL OF EVIDENCE: Level III, Retrospective cohort study.

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Long-term results of abrasion arthroplasty for full-thickness cartilage lesions of the medial femoral condyle.

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Journal Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
Year 2015
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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PURPOSE: To evaluate the long-term functional results of arthroscopic abrasion arthroplasty for the treatment of full-thickness cartilage lesions of the medial femoral condyle. METHODS: Between 1990 and 1996, 75 consecutive patients with isolated chondral lesions of the medial femoral condyle were treated with arthroscopic chondral abrasion. A retrospective analysis of the clinical results of this cohort was performed. The patients were evaluated according to the Knee Society Score questionnaire preoperatively, at 10 years postoperatively, and at final long-term follow-up at a mean of 20 years. At final follow-up, they were also assessed according to the Western Ontario and McMaster Universities Osteoarthritis Index. Patients were divided according to the lesion size and by age, and the Kaplan-Meier survivorship function (with second operation taken as an endpoint) for the various groups was calculated. RESULTS: At a mean of final follow-up of 20 years (range, 16.94 to 23.94 years), a positive functional outcome (Knee Society Score ≥70 points or no reoperation) was recorded in 67.9% of the patients. Twenty-year survivorship in this cohort was 71.4% (95% confidence interval, 0.5690 to 0.8590). The survivorship was 89.5% for patients younger than 50 years and 55.7% for patients aged 50 years or older. The functional results for patients with lesions smaller than 4 cm(2) were significantly better than those for patients with lesions of 4 cm(2) or greater (P = .031). There were no statistical differences between patients with and without associated lesions at the time of surgery. CONCLUSIONS: Our hypothesis that there would be survivorship greater than 86% was disproved. However, arthroscopic abrasion arthroplasty can be a valid treatment for medial femoral condylar full-thickness defects of the knee, even in the long-term, particularly for younger patients and those with smaller lesions. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Primary study

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The relationship between knee arthroscopy and arthroplasty in patients under 65 years of age.

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Journal The Journal of arthroplasty
Year 2014
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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A private payer database was used to examine the incidence and rates of knee arthroscopy in patients less than 65 years of age and the subsequent risk of knee arthroplasty. Time to event analysis was performed using the Kaplan-Meier method; also, Cox regression analysis was used to evaluate the relative risk of subsequent knee arthroplasty for arthroscopic patients. Overall, 247,034 knee arthroscopies, done for injury or arthropathy, were identified between 2004 and 2009. Within 1-year of arthroscopy, 2.2% of arthropathy patients and 0.9% of injury patients underwent a knee arthroplasty. These increased to 5.2% and 2.4% at 5-years, respectively. The risk of arthroplasty following arthroscopy increased significantly with age. Further study is warranted to examine the benefit of arthroscopy in younger patients with OA.

Primary study

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Dilemma of high rate of conversion from knee arthroscopy to total knee arthroplasty.

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Journal American journal of orthopedics (Belle Mead, N.J.)
Year 2014
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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We tried to reduce our rate of conversion from index knee arthroscopy to total knee arthroplasty (TKA) for degenerative pathology (primarily meniscal) in the setting of coexisting arthritis in patients 50 years or older. We hypothesized that, by using a 2-surgeon independent evaluation method, we could reduce the rate to less than 10% by 3-year follow-up. Forty-two consecutive patients were initially evaluated by the knee replacement surgeon to determine if they were TKA candidates. They were then independently evaluated by another surgeon regarding the need for TKA and the possibility of arthroscopic debridement. The data showed a tendency: The under-10% target rate was nearly reached in patients younger than 65 years (12%; 2/17) but not in patients older than 65 years (36%; 9/25). The overall rate of conversion to TKA was 26%. The 2 main groups (arthroscopy only, arthroscopy-plus-TKA) did not differ in all measured characteristics. Failure of our method to achieve better outcomes demonstrates that conventional criteria are poor in predicting which patients with meniscal pathology, which is believed to be relatively more symptomatic than coexisting arthritis, should avoid arthroscopy and go straight to TKA.

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Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial.

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Journal British journal of anaesthesia
Year 2013
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This article is included in 10 Systematic reviews Systematic reviews (10 references)

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<b>BACKGROUND: </b>High-dose glucocorticoid may reduce postsurgical pain and improve recovery. We hypothesized that 125 mg methylprednisolone (MP) would reduce time to meet functional discharge criteria after total hip arthroplasty (THA).<b>METHODS: </b>Forty-eight patients undergoing unilateral THA under spinal anaesthesia were consecutively included in this randomized, double-blind, placebo-controlled trial receiving preoperative i.v. MP or saline. All patients received a standardized, multimodal analgesic regime with paracetamol, celecoxib, and gabapentin. The primary outcome was time to meet well-defined functional discharge criteria. Secondary outcomes were handgrip strength and endurance, pain, nausea, vomiting, fatigue, sleep quality, and rescue analgesic-, antiemetic-, and hypnotic medicine requirements. The inflammatory response measured by C-reactive protein (CRP) and actual length of stay were also registered. Discharge criteria were assessed twice daily (at 09:00 and 14:00 h) until discharge. Other outcomes were assessed at 2, 4, 6, 8, and 24 h after operation, and also in a questionnaire from postoperative day (POD) 1-4.<b>RESULTS: </b>Time to meet discharge criteria was [median (IQR) (95% CI), MP vs placebo]: 23.5 (23.3-23.7) (17.8-43.8) vs 23.5 (23.0-23.8) (20.0-46.8) h, the mean difference (95% CI) being -1.3 (-4.7 to 2.2) h, P=0.65. Overall pain for the first 24 h after surgery was significantly reduced in the MP vs the placebo group (P&lt;0.01), as was CRP at 24 h (P&lt;0.0001). No other between-group differences were observed. No drug-related complications were observed at follow-up on POD30.<b>CONCLUSIONS: </b>MP 125 mg i.v. before surgery added to a multimodal oral analgesic regime did not reduce time to meet functional discharge criteria after THA, but improved analgesia for the first 24 h.

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

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Journal BMC musculoskeletal disorders
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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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.

Primary study

Unclassified

Ten-year survivorship after knee arthroscopy in patients with Kellgren-Lawrence grade 3 and grade 4 osteoarthritis of the knee.

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Journal Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
Year 2013
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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PURPOSE: The purpose of this study was to document 10-year outcomes and total knee arthroplasty (TKA) rate after arthroscopic treatment of knee osteoarthritis and compare survivorship of patients with Kellgren-Lawrence (KL) grade 3 and 4 knees. METHODS: Eighty-one knees in 73 patients (49 male, 32 female; mean age, 58 years; range, 37 to 79 years) that underwent an arthroscopic regimen for knee osteoarthritis between August 2000 and November 2001 were included in this institutional review board-approved study. The inclusion criterion was Kellgren-Lawrence (KL) grade 3 or 4 radiographic changes. A TKA had been recommended to all patients; however, none wished to undergo arthroplasty. All patients underwent arthroscopic treatment. Endpoint was defined as TKA for survivorship analysis. Outcomes were collected at a minimum follow-up of 10 years (Lysholm, Tegner, patient satisfaction, and WOMAC scores). RESULTS: Of 81 knees, 7 were in patients who died and 2 in patients who refused to participate, leaving 72 knees available for follow-up. Follow-up was obtained for 95% of patients (n = 69). Forty-three knees (62%) were converted to TKA at a mean of 4.4 years (range 1.0 to 9.6) after index arthroscopy. Mean survival time was 6.8 years (95% confidence interval [CI], 5.9 to 7.6 years). Survivorship was 60% at 5 years and 40% at 10 years. Patients with KL grade 4 osteoarthritis were 5.3 times more likely to fail (95% CI, 1.3 to 23.4) than those with KL grade 3 (P = .012). Mean survival time for patients with KL grade 4 was 5.7 years (95% CI, 4.5 to 6.9), and mean survival time for those with KL grade 3 was 7.5 years (95% CI, 6.2 to 8.7) (P = .022). For 26 knees that did not undergo arthroplasty, the mean Lysholm score was 74 (95% CI, 67 to 80), the median Tegner activity scale score was 3 (range, 0 to 8), the median patient satisfaction with outcome was 9 (range, 1 to 10), and the mean WOMAC score was 18.5 (95% CI, 13 to 24) at 10 years of follow-up. CONCLUSIONS: The mean survival time after arthroscopic treatment of osteoarthritis with a defined protocol was 6.8 years. Forty percent delayed arthroplasty for a minimum of 10 years. Patients with KL grade 4 changes in their knee had a higher risk of conversion to arthroplasty and a significantly lower mean survival time. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Primary study

Unclassified

Effects of periarticular steroid injection on knee function and the inflammatory response following Unicondylar Knee Arthroplasty.

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Authors Ng YC , Lo NN , Yang KY , Chia SL , Chong HC , Yeo SJ
Journal Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
Year 2011
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This article is included in 3 Systematic reviews Systematic reviews (3 references)

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There is little information on the values of CRP and ESR as markers for inflammation in Unicondylar Knee Arthroplasty. The effect of periarticular steroid injection in post-operative pain relief and clinical recovery has not been well studied. Eighty-three consecutive patients undergoing primary UKAs were randomized to receive either an intra-operative periarticular injection with a local anaesthetic and adrenaline or with the addition of triamcinolone acetonide. CRP and ESR values, pain VAS and other scores, as well as clinical functional parameters, were obtained and analysed. Patients were assessed daily till discharge and up to 6 months post-operatively. Plasma CRP and ESR fluctuate after a UKA, with normalizing values indicating uneventful recovery. Periarticular steroid injections reduce post-operative pain and inflammation, and are clinically relevant as they improve short-term functional recovery and clinical parameters, resulting in better outcomes for patients without having major complications.

Primary study

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Single-dose periarticular steroid infiltration for pain management in total knee arthroplasty: a prospective, double-blind, randomised controlled trial.

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Authors Sean VW , Chin PL , Chia SL , Yang KY , Lo NN , Yeo SJ
Journal Singapore medical journal
Year 2011
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This article is included in 4 Systematic reviews Systematic reviews (4 references)

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INTRODUCTION: Post total knee replacement pain control using parenteral opioids results in significant side effects like nausea and vomiting. Periarticular injections are used to control pain without these side effects. This study aimed to evaluate the safety and efficacy of periarticular steroid injection in patients undergoing total knee arthroplasty, as well as assess the patient's functional outcomes over a period of two years. METHODS: A total of 100 patients who underwent total knee arthroplasty were randomised into two groups. The treatment group received periarticular infiltration with triamcinolone acetonide, bupivacaine and epinephrine. The control group received only bupivacaine and epinephrine. The postoperative analgesic regime was standardised for all patients. The immediate postoperative outcomes evaluated included pain score, morphine consumption, time to ambulation, straight leg raise, range of motion and duration of hospital stay. Longer-term outcomes were assessed at 1, 3, 6 and 24 months using the SF-36 questionnaire and Oxford Knee Score. RESULTS: Patients in the treatment group had significantly lower pain scores, reduced morphine consumption and earlier discharge. They also had better range of knee motion and were able to regain muscular strength earlier. There was no increase in major complications such as infection or tendon rupture in the treatment group. There was no difference between the groups with regard to the medium-term outcomes of up to two years. CONCLUSION: This modality of pain control is safe and efficacious for post total knee replacement pain control.