Arthroscopic washout of the knee—a 5-year survival analysis

Bernard, J; Lemon, M.; Patterson, Miki

doi:10.1016/s0968-0160(03)00108-x

Cited by 22 publications

(12 citation statements)

References 11 publications

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“…Our findings are consistent with studies showing that OA severity and age are associated with TKA [ 22 – 32 ]. Indeed, surgeons may be reluctant to offer TKA to younger patients, because they face a risk of a revision TKA.…”

Section: Discussionsupporting

confidence: 93%

The likelihood of total knee arthroplasty following arthroscopic surgery for osteoarthritis: a systematic review

Winter¹,

Collins

Katz³

2017

BMC Musculoskelet Disord

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BackgroundArthroscopic surgery is a common treatment for knee osteoarthritis (OA), particularly for symptomatic meniscal tear. Many patients with knee OA who have arthroscopies go on to have total knee arthroplasty (TKA). Several individual studies have investigated the interval between knee arthroscopy and TKA. Our objective was to summarize published literature on the risk of TKA following knee arthroscopy, the duration between arthroscopy and TKA, and risk factors for TKA following knee arthroscopy.MethodsWe searched PubMed, Embase, and Web of Science for English language manuscripts reporting TKA following arthroscopy for knee OA. We identified 511 manuscripts, of which 20 met the inclusion criteria and were used for analysis. We compared the cumulative incidence of TKA following arthroscopy in each study arm, stratifying by type of data source (registry vs. clinical), and whether the study was limited to older patients (≥ 50) or those with more severe radiographic OA. We estimated cumulative incidence of TKA following arthroscopy by dividing the number of TKAs among persons who underwent arthroscopy by the number of persons who underwent arthroscopy. Annual incidence was calculated by dividing cumulative incidence by the mean years of follow-up.ResultsOverall, the annual incidence of TKA after arthroscopic surgery for OA was 2.62% (95% CI 1.73–3.51%). We calculated the annual incidence of TKA following arthroscopy in four separate groups defined by data source (registry vs. clinical cohort) and whether the sample was selected for disease progression (either age or OA severity). In unselected registry studies the annual TKA incidence was 1.99% (95% CI 1.03–2.96%), compared to 3.89% (95% CI 0.69–7.09%) in registry studies of older patients. In unselected clinical cohorts the annual incidence was 2.02% (95% CI 0.67–3.36%), while in clinical cohorts with more severe OA the annual incidence was 4.13% (95% CI 1.81–6.44%). The mean and median duration between arthroscopy and TKA (years) were 3.4 and 2.0 years.ConclusionsClinicians and patients considering knee arthroscopy should discuss the likelihood of subsequent TKA as they weigh risks and benefits of surgery. Patients who are older or have more severe OA are at particularly high risk of TKA.Electronic supplementary materialThe online version of this article (10.1186/s12891-017-1765-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 93%

The likelihood of total knee arthroplasty following arthroscopic surgery for osteoarthritis: a systematic review

Winter¹,

Collins

Katz³

2017

BMC Musculoskelet Disord

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“…The continual decline in irrigation before the introduction of the NICE guidance may suggest that surgeons were already aware of the poor outcomes associated with arthroscopy for knee OA. 25 The peak in the number of loose bodies removed after the publication of the NICE guidance, however, is difficult to explain, especially considering the rate was almost constant before the guidance was published.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic washout of the knee: A procedure in decline

et al. 2014

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“…Two studies that reported failure rates for debridement were used for BSC following initial and subsequent treatment failure in the analysis: Forster et al 147 reported a failure rate of 20.0% at 1 year (converted monthly rate was 1.84%) and Bernard et al 148 reported a failure rate of 18.0% at 5 years (converted monthly rate was 0.33%). The latter value was used in the SA.…”

Section: Subsequent Treatmentmentioning

confidence: 99%

Autologous chondrocyte implantation in the knee: systematic review and economic evaluation

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

213

164

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BackgroundThe surfaces of the bones in the knee are covered with articular cartilage, a rubber-like substance that is very smooth, allowing frictionless movement in the joint and acting as a shock absorber. The cells that form the cartilage are called chondrocytes. Natural cartilage is called hyaline cartilage. Articular cartilage has very little capacity for self-repair, so damage may be permanent. Various methods have been used to try to repair cartilage. Autologous chondrocyte implantation (ACI) involves laboratory culture of cartilage-producing cells from the knee and then implanting them into the chondral defect.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of ACI in chondral defects in the knee, compared with microfracture (MF).Data sourcesA broad search was done in MEDLINE, EMBASE, The Cochrane Library, NHS Economic Evaluation Database and Web of Science, for studies published since the last Health Technology Assessment review.Review methodsSystematic review of recent reviews, trials, long-term observational studies and economic evaluations of the use of ACI and MF for repairing symptomatic articular cartilage defects of the knee. A new economic model was constructed. Submissions from two manufacturers and the ACTIVE (Autologous Chondrocyte Transplantation/Implantation Versus Existing Treatment) trial group were reviewed. Survival analysis was based on long-term observational studies.ResultsFour randomised controlled trials (RCTs) published since the last appraisal provided evidence on the efficacy of ACI. The SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial compared matrix-applied chondrocyte implantation (MACI®) against MF. The TIG/ACT/01/2000 (TIG/ACT) trial compared ACI with characterised chondrocytes against MF. The ACTIVE trial compared several forms of ACI against standard treatments, mainly MF. In the SUMMIT trial, improvements in knee injury and osteoarthritis outcome scores (KOOSs), and the proportion of responders, were greater in the MACI group than in the MF group. In the TIG/ACT trial there was improvement in the KOOS at 60 months, but no difference between ACI and MF overall. Patients with onset of symptoms < 3 years’ duration did better with ACI. Results from ACTIVE have not yet been published. Survival analysis suggests that long-term results are better with ACI than with MF. Economic modelling suggested that ACI was cost-effective compared with MF across a range of scenarios.LimitationsThe main limitation is the lack of RCT data beyond 5 years of follow-up. A second is that the techniques of ACI are evolving, so long-term data come from trials using forms of ACI that are now superseded. In the modelling, we therefore assumed that durability of cartilage repair as seen in studies of older forms of ACI could be applied in modelling of newer forms. A third is that the high list prices of chondrocytes are reduced by confidential discounting. The main research needs are for longer-term follow-up and for trials of the next generation of ACI.ConclusionsThe evidence base for ACI has improved since the last appraisal by the National Institute for Health and Care Excellence. In most analyses, the incremental cost-effectiveness ratios for ACI compared with MF appear to be within a range usually considered acceptable. Research is needed into long-term results of new forms of ACI.Study registrationThis study is registered as PROSPERO CRD42014013083.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Arthroscopic washout of the knee—a 5-year survival analysis

Cited by 22 publications

References 11 publications

The likelihood of total knee arthroplasty following arthroscopic surgery for osteoarthritis: a systematic review

The likelihood of total knee arthroplasty following arthroscopic surgery for osteoarthritis: a systematic review

Arthroscopic washout of the knee: A procedure in decline

Autologous chondrocyte implantation in the knee: systematic review and economic evaluation

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