Arthroscopic Chondroplasty Increases Risk of Additional Knee Arthroplasty

Simon Abram, PhD

Patients with knee arthroplasty who were treated with arthroscopic chondroplasty were at a greater risk of additional knee arthroplasty than the general population, recent study findings showed.

Simon Abram, PhD, and a team of colleagues identified patients in England who were undergoing arthroscopic chondroplasty to analyze the rate of knee arthroplasty in the population of patients with a history of arthroscopic chondroplasty. The team found that patients who underwent knee chondroplasty procedures had a 17-times increased risk of receiving knee arthroplasty compared to general population.

The findings could inform patients of the anticipated outcomes following the knee procedure.

Abram, from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at University of Oxford in England, and the investigative team obtained National Hospital Episode Statistics data from National Health Service Digital. The National Hospital Episode Statistics data were deidentified and submitted by hospitals to claim payment for services they provided.

The data included episodes of care delivered in treatment centers funded by the National Health Service, episodes of care in England where patients were resident outside of England, and privately funded patients treated within the National Health Services England hospitals.

The team of investigators extracted all the records between April 1, 2007-March 31, 2017 for patients undergoing arthroscopic chondroplasty. The primary outcome of the study was knee arthroplasty matched to the side of any previous chondroplasty.

Over the 10-year study period, there were 157,730 chondroplasty patients were identified, with a mean age of 51.7 years old and 48.1% female. Nearly 604,100 patients underwent knee arthroplasty and 5.95% had a record of a previous chondroplasty.

After chondroplasty, 5.91% (95% CI, 5.78-6.03) of patients underwent knee arthroplasty within 1 year; 9.41% (95% CI, 9.24-9.58) within 2 years; 14.22% (95% CI, 13.94-14.51) within 5 years; and 17.61% (95% CI, 17.03-18.2) within 8 years.

Arthroplasty risk was higher among female patients (aHR, 1.38; 95% CI, 1.34-1.42) and in older patients (aHR 1.33 per 5 years; 95% CI, 1.32-1.34). Patients with a higher comorbidity index also had an increased risk of undergoing arthroplasty (aHR, 1.03 per 5 units Charlson index; 95% CI, 1.01-1.05).

Risk of arthroplasty after chondroplasty fell slightly over time by year of chondroplasty treatment (aHR, .95 per 5 years; 95% CI, .92-.98). If a patient underwent meniscal surgery at the same time, they were at greater risk of subsequent arthroplasty (aHR, 1.09; 95% CI, 1.06-1.13).

Patients who were >30 years old with a history of chondroplasty were 17.32-times (95% CI, 16.81-17.84) more likely to undergo arthroplasty than those among the general population without a history of chondroplasty. The rate of arthroplasty was 3.49% (95% CI, 3.39-3.6) in patients >30 years old with a history of chondroplasty in 2016-2017 and .2% (95% CI, 0.19-0.2) in patients without chondroplasty.

The data findings could help inform both patients and clinicians of the long-term outcomes following the procedure at the population level.

The study, “Rates of knee arthroplasty in patients with a history of arthroscopic chondroplasty results from a retrospective cohort study utilizing the National Hospital Episode Statistics for England,” was published online in BMJ Open.