medwireNews: Results of a systematic review suggest that older patients and those with more severe osteoarthritis (OA) have an elevated risk for undergoing total knee arthroplasty (TKA) following arthroscopic surgery.
“A concern about the use of arthroscopic surgery in the setting of OA and OA with meniscal tear is that [arthroscopic partial meniscectomies] may lead to more rapid OA progression, leading to TKA more quickly,” say Jeffrey Katz (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and study co-authors.
The team analyzed data from 20 published analyses involving 28 individual study arms – 16 clinical cohorts and 12 registry datasets – and found that the overall average annual incidence of TKA after arthroscopic surgery for knee OA was 2.62%. Patients underwent TKA a mean of 3.4 years after arthroscopy.
In the three registry-based studies that involved participants aged 50 years or older, and the nine clinical cohorts including patients with more advanced OA based on a Kellgren–Lawrence grade of 3 or above or an Outerbridge score of at least 2 points, the average annual incidence of TKA was 3.89% and 4.13%, respectively.
Logistic regression models showed that participants of studies that selected patients based on OA severity or older age were approximately twice as likely to undergo TKA as those involved in studies with unselected participants, with annual rates of 4.05% versus 2.00%.
And the annual incidence of TKA was significantly higher in studies involving patients with a mean age above versus below 65 years, at 5.13% versus 1.87%.
These findings indicate that “[p]atients who are older or have more severe OA are at particularly high risk of TKA” following arthroscopic surgery, write the authors in BMC Musculoskeletal Disorders.
Katz and colleagues caution that the registry-based studies included in their systematic review did not provide details on the surgical procedures, and there was limited information on “subgroups that might be prognostically distinct, such as athletes and non-athletes, or males and females.”
Nevertheless, they believe that “OA patients undergoing arthroscopy and their physicians should anticipate an annual rate of TKA on the order of 2%.”
And the researchers conclude: “Clinicians and patients considering knee arthroscopy should discuss the likelihood of subsequent TKA as they weigh risks and benefits of surgery.”
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