Summary

5.2% of patients underwent knee arthroscopy in the year prior to TKA despite literature support and clinical recommendations against its use.

Abstract

Introduction

The cost-effectiveness of arthroscopic knee procedures has been found to be similar to several nonoperative treatments for knee osteoarthritis. However, the utilization rate of arthroscopic knee procedures preceding total knee arthroplasty (TKA) remains high, and may result in poor postoperative outcomes when performed in the year prior to TKA. The purpose of this study is to describe the prevalence and costs of knee arthroscopic procedures performed in the one-year period prior to a primary TKA procedure, and the impact of arthroscopic procedures on TKA outcomes.

Methods

An observational cohort study was conducted using the IBM Watson Health MarketScan databases from January 1, 2017, to December 31, 2019. Knee arthroscopic procedures performed in the one-year period before a primary TKA were identified. The primary outcomes of interest were cost of these procedures, and the risk of 90-day postoperative complications.

Results

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 $9716 ± 5500 in the highest payment quartile, versus $1789 ± 636 in the lowest payment quartile. No differences were found in the risk of 90-day postoperative infection between patients with and without a history of knee arthroscopic procedures.

Conclusion

5.2% of patients underwent knee arthroscopy in the year prior to TKA despite literature support and clinical recommendations against its use. 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.