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Randomized Controlled Trial
. 2024 Apr 1;7(4):e246578.
doi: 10.1001/jamanetworkopen.2024.6578.

Incidence of Total Knee Arthroplasty After Arthroscopic Surgery for Knee Osteoarthritis: A Secondary Analysis of a Randomized Clinical Trial

Trevor B Birmingham  1   2   3 , Codie A Primeau  1   2   3 , Salimah Z Shariff  3   4   5 , Jennifer N S Reid  4 , Jacquelyn D Marsh  2   3 , Melody Lam  4 , Stephanie N Dixon  4   6 , J Robert Giffin  1   3   7 , Kevin R Willits  1   3   7 , Robert B Litchfield  1   3   7 , Brian G Feagan  6   8 , Peter J Fowler  1   3   7
Affiliations
Randomized Controlled Trial

Incidence of Total Knee Arthroplasty After Arthroscopic Surgery for Knee Osteoarthritis: A Secondary Analysis of a Randomized Clinical Trial

Trevor B Birmingham et al. JAMA Netw Open. .

Abstract

Importance: It is unclear whether arthroscopic resection of degenerative knee tissues among patients with osteoarthritis (OA) of the knee delays or hastens total knee arthroplasty (TKA); opposite findings have been reported.

Objective: To compare the long-term incidence of TKA in patients with OA of the knee after nonoperative management with or without additional arthroscopic surgery.

Design, setting, and participants: In this ad hoc secondary analysis of a single-center, assessor-blinded randomized clinical trial performed from January 1, 1999, to August 31, 2007, 178 patients were followed up through March 31, 2019. Participants included adults diagnosed with OA of the knee referred for potential arthroscopic surgery in a tertiary care center specializing in orthopedics in London, Ontario, Canada. All participants from the original randomized clinical trial were included. Data were analyzed from June 1, 2021, to October 20, 2022.

Exposures: Arthroscopic surgery (resection or debridement of degenerative tears of the menisci, fragments of articular cartilage, or chondral flaps and osteophytes that prevented full extension) plus nonoperative management (physical therapy plus medications as required) compared with nonoperative management only (control).

Main outcomes and measures: Total knee arthroplasty was identified by linking the randomized trial data with prospectively collected Canadian health administrative datasets where participants were followed up for a maximum of 20 years. Multivariable Cox proportional hazards regression models were used to compare the incidence of TKA between intervention groups.

Results: A total of 178 of 277 eligible patients (64.3%; 112 [62.9%] female; mean [SD] age, 59.0 [10.0] years) were included. The mean (SD) body mass index was 31.0 (6.5). With a median follow-up of 13.8 (IQR, 8.4-16.8) years, 31 of 92 patients (33.7%) in the arthroscopic surgery group vs 36 of 86 (41.9%) in the control group underwent TKA (adjusted hazard ratio [HR], 0.85 [95% CI, 0.52-1.40]). Results were similar when accounting for crossovers to arthroscopic surgery (13 of 86 [15.1%]) during follow-up (HR, 0.88 [95% CI, 0.53-1.44]). Within 5 years, the cumulative incidence was 10.2% vs 9.3% in the arthroscopic surgery group and control group, respectively (time-stratified HR for 0-5 years, 1.06 [95% CI, 0.41-2.75]); within 10 years, the cumulative incidence was 23.3% vs 21.4%, respectively (time-stratified HR for 5-10 years, 1.06 [95% CI, 0.45-2.51]). Sensitivity analyses yielded consistent results.

Conclusions and relevance: In this secondary analysis of a randomized clinical trial of arthroscopic surgery for patients with OA of the knee, a statistically significant association with delaying or hastening TKA was not identified. Approximately 80% of patients did not undergo TKA within 10 years of nonoperative management with or without additional knee arthroscopic surgery.

Trial registration: ClinicalTrials.gov Identifier: NCT00158431.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Birmingham reported receiving grant funding from the Canadian Institutes of Health Research (CIHR) during the conduct of the study and outside the submitted work. Dr Shariff reported performing contracted services for the University of Western Ontario during the conduct of the study. Ms Reid reported performing contracted services for the University of Western Ontario during the conduct of the study. Ms Lam reported performing contracted services for the University of Western Ontario during the conduct of the study. Dr Giffin reported receiving grant funding from the CIHR during the conduct of the study. Dr Litchfield reported receiving royalties from Smith+Nephew, consulting for CONMED Corporation, and receiving nonfinancial support as a medical officer for ARC Medical Inc outside the submitted work. No other conflicts were disclosed.

Figures

Figure.
Figure.. Time to Event Curve for Primary and Secondary Outcomes
Kaplan-Meier estimates and cumulative incidence of the primary end point of total knee arthroplasty (TKA) on the study knee (A) and the secondary end point of total knee arthroplasty or high tibial osteotomy on either knee (B) are shown for patients randomly assigned to knee arthroscopic surgery plus nonoperative care (n = 92) or nonoperative care only (control) (n = 86).
See this image and copyright information in PMC

References

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