Arthroscopic Procedures Are Performed in 5% of Patients With Knee Osteoarthritis 1 Year Preceding Total Knee Arthroplasty and Are Associated With Increased Stiffness and Increased Costs

Darren Z Nin; Ya-Wen Chen; Carl T Talmo; Brian L Hollenbeck; Ruijia Niu; David C Chang; Eric L Smith; David Mattingly

doi:10.1016/j.asmr.2023.100776

Arthroscopic Procedures Are Performed in 5% of Patients With Knee Osteoarthritis 1 Year Preceding Total Knee Arthroplasty and Are Associated With Increased Stiffness and Increased Costs

Arthrosc Sports Med Rehabil. 2023 Aug 19;5(6):100776. doi: 10.1016/j.asmr.2023.100776. eCollection 2023 Dec.

Authors

Darren Z Nin^{1

2}, Ya-Wen Chen², Carl T Talmo¹, Brian L Hollenbeck³, Ruijia Niu¹, David C Chang^{1

2}, Eric L Smith¹, David Mattingly¹

Affiliations

¹ Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts, U.S.A.
² Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
³ Division of Infectious Diseases, New England Baptist Hospital, Boston, Massachusetts, U.S.A.

Abstract

Purpose: To describe the different types of arthroscopic procedures that patients undergo in the year prior to total knee arthroplasty (TKA), reveal the cost associated with these procedures, and understand the relationship between preoperative arthroscopy and clinical outcomes after TKA.

Methods: An observational cohort study was conducted using the IBM Watson Health MarketScan databases. Patients with knee osteoarthritis who underwent unilateral isolated primary TKA between January 1, 2018, and September 30, 2019, were included. Knee arthroscopic procedures performed in the 1-year period before a primary TKA was identified. The primary outcomes of interest were cost of these procedures and the risk of 90-day postoperative complications.

Results: In total, 2,904 patients, representing 5.2% of the analyzed cohort, underwent arthroscopic procedures in the year prior to TKA. The most common procedure and diagnosis were meniscectomy and meniscal tear, respectively, with procedures performed an average of 7.2 ± 3.0 months before TKA. Average per patient costs were $9,716 ± $5,500 in the highest payment quartile vs $1,789 ± 636 in the lowest payment quartile. Patients with a history of arthroscopy were more likely to develop postoperative stiffness (P = .001), while no difference was found in the risk of 90-day periprosthetic joint infection (PJI).

Conclusions: Of the patients, 5.2% underwent knee arthroscopy in the year prior to TKA. While no association was seen with PJI risk, the costs associated with these procedures are high and may increase the overall cost of management of knee osteoarthritis.

Level of evidence: Level III, retrospective comparative study.