Our Summary

This research paper is looking at how knee surgeries have changed over time for patients with arthritis in their knees. Specifically, it is looking at how often a surgery called arthroscopy is done and whether it leads to another type of surgery, called arthroplasty, within two years.

Arthroscopy is a procedure where a small camera is inserted into the knee to view and treat the joint, while arthroplasty is a surgery to replace all or part of a joint. Previous studies suggested that arthroscopy wasn’t effective for knee arthritis, but it’s unclear how this has affected how often the procedure is done.

The researchers looked at patients aged 50 and over who had knee arthritis and had undergone arthroscopy between 1998 and 2010. They found that between 1998 and 2002, the number of these surgeries decreased slightly from 4% to 3% of the patients. However, between 2006 and 2010, the rate increased back to 4%. They also found that the percentage of these surgeries that were followed by arthroplasty within two years went from 4% to 5% over the entire period.

In conclusion, the study found that the rate of arthroscopy surgeries for knee arthritis and the rate of these surgeries leading to arthroplasty within two years hasn’t gone down over time. This suggests that the previous research showing arthroscopy isn’t effective hasn’t had a big impact on how often it’s done. Or, it could be that these surgeries were already so rare in this group of patients that the earlier research didn’t make a big difference.

FAQs

  1. Have rates of knee arthroscopy in patients with osteoarthritis changed since the publication of the initial clinical trial in 2002?
  2. Has the conversion rate to arthroplasty within 2 years of arthroscopy changed over time?
  3. Did the results of the initial clinical trial have a substantial effect on arthroscopy rates for arthritis in the Veterans Health Administration system?

Doctor’s Tip

A helpful tip a doctor might tell a patient about arthroscopy is that while it can be a useful tool for diagnosing and treating certain knee conditions, such as meniscus tears or ligament injuries, it may not be as effective for treating knee osteoarthritis. Patients should discuss the potential risks and benefits of arthroscopy with their doctor and explore other treatment options for managing their arthritis symptoms. It is important to have a thorough understanding of the procedure and its potential outcomes before making a decision to undergo arthroscopy.

Suitable For

Patients who are typically recommended arthroscopy are those with knee osteoarthritis who have not responded to conservative treatments such as physical therapy, medications, and injections. Arthroscopy may be recommended for patients with symptomatic osteoarthritis who have persistent pain, swelling, stiffness, and limited mobility that affects their quality of life. It is important for patients to have a thorough evaluation by a healthcare provider to determine if arthroscopy is the appropriate treatment option for their specific condition.

Timeline

Before arthroscopy:

  • Patient experiences knee pain and stiffness, possibly accompanied by swelling
  • Patient consults with orthopedic surgeon and undergoes diagnostic tests such as x-rays or MRI
  • Surgeon recommends arthroscopy as a minimally invasive procedure to diagnose and potentially treat the underlying issue
  • Patient schedules arthroscopy procedure and receives instructions for pre-operative preparation

After arthroscopy:

  • Patient undergoes arthroscopy procedure under anesthesia
  • Surgeon inserts a small camera into the knee joint to examine the area and potentially perform repairs such as removing damaged tissue or smoothing out rough surfaces
  • Patient is monitored post-operatively and may be prescribed pain medication and physical therapy
  • Patient follows post-operative instructions for recovery, including rest, icing, and exercises to improve strength and flexibility
  • Patient follows up with surgeon for follow-up appointments to monitor healing and discuss next steps if necessary, such as arthroplasty if the knee does not improve with arthroscopy.

What to Ask Your Doctor

  1. Is arthroscopy the best treatment option for my knee osteoarthritis?
  2. What are the potential risks and complications associated with arthroscopy?
  3. How long is the recovery time after arthroscopy?
  4. Are there alternative treatments or therapies that I should consider before undergoing arthroscopy?
  5. What are the chances that I may need a knee arthroplasty (joint replacement) within 2 years of arthroscopy?
  6. Are there specific factors about my condition that make me a good candidate for arthroscopy?
  7. How experienced are you in performing knee arthroscopy procedures?
  8. What can I expect in terms of pain relief and improved function after arthroscopy?
  9. How will I be monitored and supported during the post-operative period?
  10. How often do you perform knee arthroplasty surgeries on patients who have previously undergone arthroscopy?

Reference

Authors: Adelani MA, Harris AH, Bowe TR, Giori NJ. Journal: Clin Orthop Relat Res. 2016 Feb;474(2):489-94. doi: 10.1007/s11999-015-4514-4. Epub 2015 Aug 20. PMID: 26290345