KS15: FROM ARTHROSCOPY TO TOTAL KNEE REPLACEMENT: A 15 YEAR FOLLOW-UP OF A SINGLE SURGEON’S PRACTICE

Abstract

Background: Arthroscopy of the knee is one of the commonest procedures performed by orthopaedic surgeons in Australia today. Total knee replacement (TKR) is also a common procedure, however, there appears to be no indication as to how many patients whom have undergone arthroscopy subsequently undergo TKR. The role of this study was to develop an understanding of the rates of progression from knee arthroscopy to TKR and to develop an appreciation of the role of knee arthroscopy in delaying arthroplasty.

Methods: We conducted a retrospective case note review for all patient’s whom had undergone a knee arthroscopy, for a single year, conducted be a single orthopaedic surgeon. These patients were followed up over a period of 15 years to establish whom subsequently underwent TKR.

Results: A total of 473 knee arthroscopies were conducted, with a total of 11 (2.75% of patients) undergoing a TKR over the course of the following 15 year period. Patient characteristics for those who underwent TKR were mean age 59.3 years (range 41–70) and mean time between initial arthroscopy and TKR was 71.3 months (range 5 – 178). All patients who underwent TKR, on initial arthroscopy had defects in multiple compartments. Two patients underwent TKR within 5 months of arthroscopy due to significant findings on arthroscopy and ongoing symptoms.

Discussion: Our results suggest a very low rate of progression to TKR following arthroscopy. Following exclusion of patients who were scheduled for TKR immediately post arthroscopy (< 6 months), mean time to TKR was approximately 8 years. These findings are considered to show the importance of arthroscopy in managing knee complaints given that there are no statistics in the literature to suggest the rate of progression from arthroscopy to TKR.

Conclusion: Arthroscopy is a practical and valuable procedure with minimal associated morbidity or complications. Accuracy of diagnosis helps to avoid unnecessary operations (including TKR). These results are important given that life expectancy is increasing, the age at which individuals are undergoing TKR is decreasing and the limited duration of life of TKR.