Arthroscopy Doesn’t Delay Total Knee Replacement in OA

TOPLINE:

Adding arthroscopic surgery to nonoperative management neither delays nor accelerates the timing of total knee arthroplasty (TKA) in patients with knee osteoarthritis (OA).

METHODOLOGY:

  • Some case series show that arthroscopic surgery for knee OA may delay more invasive procedures, such as TKA or osteotomy, while longitudinal cohort studies often contradict this. Current OA guidelines are yet to address this issue.
  • This secondary analysis of a randomized trial compared the long-term incidence of TKA in 178 patients (mean age, 59 years; 64.3% women) with knee OA who were referred for potential arthroscopic surgery at a tertiary care center in Canada.
  • The patients received nonoperative care with or without additional arthroscopic surgery.
  • Patients in the arthroscopic surgery group had specific knee procedures (resection of degenerative knee tissues) along with nonoperative management (physical therapy plus medications as required), while the control group received nonoperative management alone.
  • The primary outcome was TKA on the knee being studied, and the secondary outcome was TKA or osteotomy on either knee.

TAKEAWAY:

  • During a median follow-up of 13.8 years, 37.6% of patients underwent TKA, with comparable proportions of patients in the arthroscopic surgery and control groups undergoing TKA (adjusted hazard ratio [aHR], 0.85; 95% CI, 0.52-1.40).
  • The rates of TKA or osteotomy on either knee were similar in both groups (aHR, 0.91; 95% CI, 0.59-1.41).
  • A time-stratified analysis done for 0-5 years, 5-10 years, and beyond 10 years of follow-up also showed a consistent interpretation.
  • When patients with crossover to arthroscopic surgery during the follow-up were included, the results remained similar for both the primary (HR, 0.88; 95% CI, 0.53-1.44) and secondary (HR, 1.08; 95% CI, 0.69-1.68) outcomes.

IN PRACTICE:

“Our study findings do not support the use of arthroscopic surgery for OA of the knee.” “Arthroscopic surgery does not provide additional benefit to nonoperative management for improving pain, stiffness, and function and is likely not cost-effective at 2 years of follow-up,” the authors wrote.

SOURCE:

This study was led by Trevor B. Birmingham, PhD, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada. It was published online on April 18, 2024, in JAMA Network Open.

LIMITATIONS:

The study was designed to assess differences in 2-year patient-reported outcomes rather than long-term TKA incidence. Factors influencing decisions to undergo TKA or osteotomy were not considered. Moreover, the effects observed in this study should be evaluated considering the estimated confidence intervals.

DISCLOSURES:

This study was supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. Some authors declared consulting, performing contracted services, or receiving grant funding, royalties, and nonfinancial support from various sources.

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