Arthroscopy prior to UKA yielded higher rates of conversion to TKA, aseptic loosening
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Results showed conversion to total knee arthroplasty or failure due to aseptic loosening were more than twice as likely to occur in patients who underwent knee arthroscopy within 2 years prior to unicompartmental knee arthroplasty.
Using the PearlDiver database, Safa C. Fassihi, MD, and colleagues categorized patients who underwent UKA from 2007 to 2017 into two groups based on whether they had a history of knee arthroscopy within 2 years prior to undergoing UKA.
“We used one to two propensity matching using age, sex, Charlson Comorbidity Index, smoking and obesity, and we had 2-year follow-up to assess our outcomes, which were rates of conversion to TKA, rates of manipulation under anesthesia, aseptic loosening, [periprosthetic joint infection] PJI and revision due to wear,” Fassihi said in his presentation at the American Association of Hip and Knee Surgeons Annual Meeting.
Fassihi noted 12.9% of patients underwent knee arthroscopy within 2 years prior to UKA. Univariate analysis showed patients with a recent history of knee arthroscopy had a significantly higher rate of conversion to TKA and failure for aseptic loosening at 2 years postoperatively, according to Fassihi.
“Importantly, the higher incidence of aseptic loosening cannot account for the large difference in conversion rates between the cohorts,” Fassihi said. “So, there is likely persistent pain or [osteoarthritis] OA progression contributing to this higher conversion rate in the arthroscopy cohort, but we cannot know for certain because these indications are not captured by distinct billing codes.”
Fassihi noted patients who underwent general and soft tissue procedures had a higher conversion rate to TKA relative to meniscal procedures.
“There is no previous literature examining specific arthroscopic procedures and their effects on UKA or even TKA,” Fassihi said. “Our findings may be due to the fact that the general and soft tissue category comprise procedures that are performed oftentimes for contractures, such as lysis of adhesions, which would make such patients ill-suited for unicompartmental arthroplasty and might necessitate earlier conversion to total knee arthroplasty.”
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Fassihi SC, et al. Paper 3. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 5-8, 2020; Dallas (hybrid meeting).
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