Risk factors for conversion to TKA following knee arthroscopy

Results from this study demonstrated women, patients 70 years and older, obese patients, those with diabetes, depression disorders and rheumatoid arthritis had a higher chance of conversion to total knee arthroplasty 2 years following a knee arthroscopy.

St. Ambrose University Journalism professor and former WQAD-TV reporter Alan Sivell, 64, is putting his 2 new knees through the paces — fulfilling a goal to ride across Iowa in RAGBRAI, July 19-25, 2015. ORA Orthopedics

by Monica Jaramillo, Healio Orthopedics Today March 7, 2017

Researchers identified 68,090 patients older than 50 years who had a knee arthroscopy for either partial meniscectomy, chondroplasty or debridement between 1998 and 2014. Investigators stratified patients who underwent total knee arthroplasty (TKA) at 1 year, 2 years or 3 years following knee arthroscopy. Patient age, race, sex, obesity, diabetes, nicotine dependence, depressive disorder and rheumatoid arthritis were among the risk factors analyzed.

Findings showed at 1 year, 2 years and 3 years, the TKA incidence was 10.1%, 13.7% and 15.6%, respectively. Investigators noted factors associated with a higher risk of conversion to TKA at 2 years included obesity, depressive disorders, rheumatoid arthritis, women, age 70 years and older, and diabetes. Patients who were aged 50 years to 54 years had the lowest chance for TKA conversion. Men had a lower risk of conversion to TKA compared with women.

When obesity was combined individually with the top risk factors for conversion to TKA, investigators found no combination had a higher relative risk compared to obesity alone.

Source Healio Orthopedics Today

Dilemma of High Rate of Conversion From Knee Arthroscopy to Total Knee Arthroplasty

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.

References

Dilemma of high rate of conversion from knee arthroscopy to total knee arthroplasty, Skedros JG, Knight AN, Thomas SC, Paluso AM, Bertin KC. Am J Orthop (Belle Mead NJ). 2014 Jul;43(7):E153-8. PDF