The Journal of Bone and Joint Surgery (American) 84:17-22 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Arthroscopic Débridement of the Knee for Osteoarthritis in Patients Fifty Years of Age or Older
Utilization and Outcomes in the Province of Ontario
Eugene K. Wai, MD, MSc,
Hans J. Kreder, MD, MPH, FRCS(C) and
Jack I. Williams, PhD
Investigation performed by the Musculoskeletal Health Status Working
Group, Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
Eugene K. Wai, MD, MSc
Hans J. Kreder, MD, MPH, FRCS(C)
Division of Orthopaedic Surgery, Sunnybrook and Women’s College
Health Sciences Centre, 2075 Bayview Avenue, Room MG-365, Toronto,
ON M4N 3M5, Canada. E-mail address for E.K. Wai: euge.wai{at}utoronto.ca
E-mail address for H.J. Kreder: hans.kreder@swchsc.on.ca
Jack I. Williams, PhD
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue—G-Wing,
Toronto, ON M4N 3M5, Canada. E-mail address: ji.williams@ices.on.ca
No benefits in any form have been received or will be received from
a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Background: There is little available information
regarding the effectiveness of arthroscopic knee débridement
for the treatment of arthritis. The purpose of this study was to
evaluate patterns of utilization of arthroscopic knee débridement
and outcomes following that procedure for the treatment of degenerative arthritis
in persons fifty years of age or older in the Province of Ontario.
Methods: All patients fifty years of age or older
who underwent elective arthroscopic knee débridement for
the treatment of degenerative arthritis between 1992 and 1996 were
identified from administrative data sets. Surgical complications
and subsequent knee replacements were noted. Population rates were compared
across the sixteen District Health Council regions within Ontario.
Outcomes were modeled as a function of patient age, gender, and
comorbidity with use of multivariate regression analysis.
Results: We identified 14,391 eligible unilateral
arthroscopic knee débridement procedures. There was a threefold
difference in the population rate of arthroscopic débridement
across geographic regions. Overall, 1330 (9.2%) of all
patients required total knee arthroplasty within one year after
the débridement. Of the 6212 patients with a minimum three-year
follow-up, 1146 (18.4%) had undergone total knee replacement
within three years following the débridement. Patients
who were at least seventy years of age were 4.7 times more likely
to have total knee arthroplasty within one year after the débridement than
were those less than sixty years of age (19.0% compared with
4.0%; p < 0.05). Patients sixty years of age or
older were more likely to have an early total knee replacement (within one
year after the débridement) in District Health Council regions
where the population rates of arthroscopic knee débridement
were higher (p = 0.04).
Conclusions: The higher rates of early total knee
arthroplasty and the significant relationship between rates of early
total knee arthroplasty and rates of utilization suggest that arthroscopic débridement
for the treatment of osteoarthritis of the knee may be overutilized
in elderly patients. Important clinical issues such as patient preference,
risk perception, and functional outcome cannot be addressed just
with the administrative data used for this study.
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