SAN DIEGO — Older age and lower surgeon volume are key risk factors for patients ofknee arthroscopy to undergo total knee arthroplasty within a year of the procedure, according to a recently presented study.
“If a patient undergoes knee arthroscopy shortly before [total knee arthroplasty] TKA, arthroscopy may have been an accessory,” Hassan Ghomrawi, PhD, said during his presentation at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
He noted that previous research suggests that 5% to 10% of patients who had a knee arthroscopy undergo TKA within a year of the procedure. “Although we know surgeons have a major role in the decision making when doing an arthroscopy, these epidemiologic studies did not evaluate the effect of surgeon characteristics or volume on outcome.”
Ghomrawi’s team used a New York database to identify 188,575 patients older than 40 years of age who underwent knee arthroscopy between 1999 and 2005. The team traced patient identifiers to locate those who underwent TKA within a year of their arthroscopy. The odds ratio model used for the study took into account gender, insurance type, comorbidities, diagnosis, type of arthroscopy and the yearly arthroscopy volume of the surgeon.
Ghomrawi and colleagues found that 42,833 patients in the study were diagnosed with arthritis. Overall 4,536 patients (2.4%) went on to receive TKA within a year of their arthroscopy.
Patients who were 70 years or older, female, had arthritis, were insured by Medicare or Medicaid and those who underwent arthroscopy with a surgeon whose workload was less than 12 arthroscopies per year were found to be more likely to undergo a subsequent TKA.
The risk of undergoing a TKA decreased with ACL reconstruction and meniscectomy.
“Our results highlight the significance of volume-outcome relationships, and call for further investigation in this area,” Ghomrawi concluded.
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