Knee arthroscopy: influence of systems for delivering healthcare on procedure rates

Hamilton, David F.; Howie, C. R.

doi:10.1136/bmj.h4720

Cited by 27 publications

(30 citation statements)

References 18 publications

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“…Similar trends of increased use have recently been reported in Denmark and the UK (Thorlund et al. 2014, Hamilton and Howie 2015). …”

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confidence: 99%

Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery

Pihl¹,

Roos²,

Nissen³

et al. 2016

Acta Orthopaedica

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Background and purpose — Patients’ expectations of outcomes following arthroscopic meniscus surgery are largely unknown. We investigated patients’ expectations concerning recovery and participation in leisure-time activities after arthroscopic meniscus surgery and the postoperative fulfillment of these.Patients and methods — The study sample consisted of 491 consecutively recruited patients (mean age 50 (SD 13) years, 55% men) who were assigned for arthroscopy on suspicion of meniscus injury and later verified by arthroscopy. Before surgery, patients completed questionnaires regarding their expectations of recovery time and postoperative participation in leisure activities. 3 months after surgery, the patients completed questionnaires on their actual level of leisure activity and their degree of satisfaction with their current knee function. We analyzed differences between the expected outcome and the actual outcome, and between fulfilled/exceeded expectations and satisfaction with knee function.Results — 478 patients (97%) completed the follow-up. 91% had expected to be fully recovered within 3 months. We found differences between patients’ preoperative expectations of participation in leisure activities postoperatively and their actual participation in these, with 59% having unfulfilled expectations (p < 0.001). Satisfaction with current knee function was associated with expectations of leisure activities being fulfilled/exceeded.Interpretation — In general, patients undergoing arthroscopic meniscus surgery were too optimistic regarding their recovery time and postoperative participation in leisure activities. This highlights the need for shared decision making which should include giving the patient information on realistic expectations of recovery time and regarding participation in leisure-time activities after meniscal surgery.

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“…Similar trends of increased use have recently been reported in Denmark and the UK (Thorlund et al. 2014, Hamilton and Howie 2015). …”

mentioning

confidence: 99%

Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery

Pihl¹,

Roos²,

Nissen³

et al. 2016

Acta Orthopaedica

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“…2011, Thorlund et al. 2014, Hamilton and Howie 2015). A recent registry-based study including information from plain radiographs, MRI, and arthroscopy found that about one-third of knee arthroscopies in Sweden were performed on patients with degenerative meniscal tears and/or osteoarthritis (Bergkvist et al.…”

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confidence: 99%

Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

et al. 2016

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Background and purpose — Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients’ characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear.Patients and methods — 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18–77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue.Results — 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment.Interpretation — Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear.

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“…With global rates of osteoarthritis on the rise, knee arthroscopy is rapidly increasing in numbers, estimating at over 200 procedures for every 100,000 people 2. Among the pediatric population, falls and sports‐related injuries dominate the requirements for arthroscopic surgery to the knee.…”

Section: Discussionmentioning

confidence: 99%

Tourniquet‐induced common peroneal nerve injury in a pediatric patient after knee arthroscopy – raising the red flag

Saw

Hee

2017

Clinical Case Reports

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Knee arthroscopy: influence of systems for delivering healthcare on procedure rates

Abstract: The “correct” rates of discretional interventions are difficult to define. However, David Hamilton and Colin Howie point out that discrepancies in usage of knee arthroscopy within the UK suggest the organisation of the care pathway may be an important determinant

Cited by 27 publications

References 18 publications

Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery

Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery

Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

Tourniquet‐induced common peroneal nerve injury in a pediatric patient after knee arthroscopy – raising the red flag

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