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. 2022 Feb 18;65(1):E114-E120.
doi: 10.1503/cjs.002221. Print 2022 Jan-Feb.

The rate of unnecessary interventions for the management of knee osteoarthritis: a population-based cohort study

Jacquelyn D Marsh  1 , Ryan Degen  2 , Trevor B Birmingham  2 , J Robert Giffin  2 , Alan Getgood  2 , Robert Litchfield  2 , Kevin Willits  2 , J Andrew McClure  2 , Blayne Welk  2
Affiliations

The rate of unnecessary interventions for the management of knee osteoarthritis: a population-based cohort study

Jacquelyn D Marsh et al. Can J Surg. .

Abstract
in English, French

Background: Several commonly used procedures for knee osteoarthritis (OA) are not supported by evidence-based guidelines. The objective of this study was to identify the proportion of patients who underwent knee arthroscopy or magnetic resonance imaging (MRI) and the timing of these procedures before total knee arthroplasty (TKA).

Methods: We conducted a retrospective cohort study using administrative data sets from Ontario, Canada. We identified the proportion of patients who underwent knee arthroscopy in the previous 10 years or an MRI in the 3 years before their primary TKA. We also evaluated the rate of arthroscopies by diagnosis. We report the timing of each outcome in relation to the TKA, rates by geographical area, and differences in rates over time.

Results: We included 142 275 patients, of whom 36 379 (25.57%) underwent knee arthroscopy (median time 2.8 [interquartile range (IQR) 1.1-6.0] years); 22% of those were within 1 year of TKA and 52% were within 3 years. The rates of arthroscopies for a diagnosis of osteoarthritis (OA) steadily decreased, while those for meniscal-related diagnoses increased over the study period (p < 0.0001). There was significant variation by region. Of the cohort, 23.2% (n = 32 989) had an MRI before their TKA, with rates significantly increasing over time (p < 0.0001).

Conclusion: A substantial proportion of patients with knee OA received diagnostic and therapeutic interventions before TKA that are contrary to clinical practice guidelines.

Contexte:: Plusieurs interventions diagnostiques ou thérapeutiques d’usage courant pour l’arthrose du genou ne s’appuient sur aucune ligne directrice fondée sur des données probantes. L’objectif de cette étude était d’établir la proportion de patients qui ont subi une arthroscopie ou une épreuve d’imagerie par résonnance magnétique (IRM), et l’intervalle entre ces interventions et l’arthroplastie pour prothèse totale du genou (PTG).

Méthodes:: Nous avons procédé à une étude de cohorte rétrospective à partir de données administratives de population en Ontario, au Canada. Nous avons établi la proportion de patients soumis à une arthroscopie du genou dans les 10 années ou une IRM dans les 3 années précédant une PTG primaire. Nous avons aussi calculé le taux d’arthroscopies par diagnostic. Nous faisons état du moment de chacune par rapport à la PTG, des taux par région, et les différences de taux avec le temps.

Résultats:: Nous avons inclus 142 275 patients, dont 36 379 (25,57 %) ont subi une arthroscopie du genou (intervalle médian 2,8 ans [intervalle interquartile (IIQ) 1,1–6,0]); 22 % d’entre eux ont reçu leur PTG dans l’année suivante et 52 % dans les 3 années suivantes. Les taux d’arthroscopies pour un diagnostic d’arthrose ont régulièrement diminué, tandis que les diagnostics liés à des problèmes de ménisque ont augmenté pendant la période de l’étude (p < 0,0001). On a noté une variation significative d’une région à l’autre. Dans cette cohorte, 23,2 % des patients (n = 32 989) avaient subi une IRM avant leur PTG, avec des taux significativement croissants avec le temps (p < 0,0001).

Conclusion:: Dans une proportion substantielle, les patients souffrant d’arthrose du genou ont subi des interventions diagnostiques et thérapeutiques pré-PTG qui sont contraires aux lignes directrices de pratique clinique.

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Conflict of interest statement

Competing interests: Trevor Birmingham reports receiving grants (paid to institution) from the Canadian Institutes of Health Research, outside the submitted work. Alan Getgood reports receiving consulting fees and research support from Smith and Nephew Inc. and research support form Ossur Inc. Dr. Getgood is on the advisory board of and has stock options with Precision OS and Spring Loaded Technologies. No other competing interests were declared.

Figures

Fig. 1
Fig. 1
Cohort development flow chart. OA = osteoarthritis; TKA = total knee arthroplasty.
Fig. 2
Fig. 2
Proportion of patients who underwent each outcome by fiscal year. MRI = magnetic resonance imaging; OA = osteoarthritis.
Fig. 3
Fig. 3
Rate of arthroscopy by diagnosis and fiscal year. OA = osteoarthritis.
Fig. 4
Fig. 4
Proportion of patients who underwent each outcome by geographical area over the 10-year period. MRI = magnetic resonance imaging.
See this image and copyright information in PMC

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