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Prior arthroscopy may decrease TKR efficacy

In a retrospective study, patients who had arthroscopy prior to TKR had an infection rate 155% higher than TKR-only patients.

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VANCOUVER, British Columbia — Patients who underwent knee arthroscopy prior to total knee replacement have both significantly higher infection rates and less postop satisfaction compared to patients who undergo TKR alone, a retrospective study suggests.

Ronald A. Navarro, MD, an orthopedic surgeon at the South Bay Medical Center in Harbor City, Calif., conducted the study with colleagues in the Kaiser Permanente Health System. Navarro presented the results here at the Arthroscopy Association of North America 24th Annual Meeting.

The retrospective review included 442 prior arthroscopy patients and 1143 TKR-only patients, according to the study. The researchers gathered data for all patients using the Kaiser Permanente total joint registry. They also performed a chart review to validate any complications or other questionable areas to supplement the registry data, Navarro said.

Patients had a mean follow-up of 63 months. In addition to using the Chi square test for statistical analysis, the researchers used multivariate logistic regression to control for group differences such as smoking, steroid use and post-traumatic arthritis, Navarro said.

The researchers found that patients in the prior arthroscopy group tended to be younger in age, male and smokers. These patients also tended to have a higher need for revision surgery compared to patients without prior knee surgery, Navarro said. Prior arthroscopy patients also had a 155% higher postoperative infection rate (P=.026) and tended to have higher rates of nerve palsy, according to the study.

Patients who underwent TKR only tended to be older and were more likely to be retired. TKR-only patients had significantly higher rates of postop satisfaction and significantly greater pain reductions (P<.001), according to the study.

“These data do call into question the safety and efficacy of arthroscopy in a patient who may need a total knee replacement in the future. A well-controlled prospective trial matching patients at the time of total knee replacement may answer this question definitively,” Navarro said.

For more information:

• Navarro RA, Paxton L, Bottom P, Fithian D. Does prior knee arthroscopy affect perioperative TKR results? #23. Presented at the Arthroscopy Association of North America 24th Annual Meeting. May 12-15, 2005. Vancouver, British Columbia.