Arthroscopic procedures could delay the need for a subsequent knee arthroplasty in older patients with end-stage osteoarthritis

Abstract

Background/objective: Arthroscopic surgery in knee osteoarthritis is controversial with many studies refuting its efficacy in recent literature. This study aims to evaluate the mean duration to knee arthroplasty, and the effect of microfracture on the need for subsequent knee arthroplasty in patients above the age of 55 undergoing arthroscopic procedures for osteoarthritis. Methods: One hundred and nine consecutive patients with diagnosed osteoarthritis who underwent arthroscopic surgery performed from January 2000 to December 2012 on patients aged 55 years and above by a single surgeon were reviewed retrospectively. Demographic data, age at operation, comorbidities, perioperative details and information of subsequent total knee arthroplasty were collected and analysed. Results: There were 38 males and 71 females in our study group. The group was predominantly Chinese (51.38%), with hypertension and hyperlipidaemia being the most common comorbidities, each affecting 57.8% of our study cohort. All patients had a preoperative radiograph and a magnetic resonance imaging confirming the diagnosis of osteoarthritis associated with meniscal tears. Fifty-eight knees underwent microfracture along with arthroscopic meniscectomy. The mean follow-up duration was 127.5 months (10.5 years, range: 67–212 months). Twenty three patients (20.91%) underwent knee arthroplasties subsequently, with the mean duration to arthroplasty being 65.0 months (5.5 years, range: 7–166 months). The odds ratio of avoiding knee arthroplasty with microfracture was 1.03 (95% CI = 0.410–2.581). Conclusion: Arthroscopic procedures could possibly delay the need for subsequent knee arthroplasty for approximately 65 months in older patients with osteoarthritis. However, microfracture does not affect the duration between therapeutic arthroscopy and subsequent arthroplasty. Our long-term retrospective study provides an additional step in the understanding of the impact of arthroscopic procedures and a prospective case–control study would be an ideal follow-up to fully justify the application of arthroscopic procedures to delay knee arthroplasty.