Arthroscopy delays TKA for about 7 years in patients with degenerative joints
ORLANDO, Fla. — Knee arthroscopy procedures led to good outcomes and long-term survivorship in patients with severe osteoarthritis, according to a recent study that showed knee arthroscopy may also be a viable alternative to total knee arthroplasty (TKA) in these patients.
“It is an effective procedure for severe degenerative joint disease and there was no reason not to do arthroscopic surgery in these patients,” J. Richard Steadman, MD, of The Steadman Clinic, in Vail, Colo., said in a presentation at the Arthroscopy Association of North America (AANA) 2012 Annual Meeting, here.
“You just have to do the right thing in the arthroscopic surgery. So you want to take care of the degenerative changes; you want to be able to have volume in the joint. Basically, that is the point. You can do things arthroscopically in these end-stage knees … Basically, we want to help people remain active and delay a joint replacement with this procedure.”
J. Richard Steadman
Steadman, who received the Richard O’Connor Research Award at the AANA 2012 Annual Meeting for this research, looked at 69 knees in patients with a mean age of 57 years who had another physician recommend they undergo total knee replacement.
Preoperatively, their knees were graded 3 or 4 on the Kellgren-Lawrence scale, according to Steadman. “These were not really total knee candidates.”
Following knee arthroscopy where Steadman performed several procedures to manage knee stiffness and pain, the patients followed a standardized rehabilitation protocol that mostly involved motion exercises. They were followed up for 10 years, mean.
Among those studied, mean overall knee survivorship was 6.8 years and 13 patients with 10-year follow-up showed good survivorship. Steadman attributed the low number of patients at the latest follow-up period, however, to the fact that many patients discontinued their follow-ups after 6.8 years, mean.
In patients with Kellgren-Lawrence grade 4 knees at baseline, the mean survival was 5.7 years.
Overall postoperative WOMAC scores were 18.5 points and patients reported a high level of satisfaction following arthroscopy.
“As a result of this procedure, we were able to sustain their knee life and have a reasonable activity level for this period of time,” Steadman said, noting that risk factors for TKA at 5 years post-arthroscopy that he identified were age over 60 years, Kellgren-Lawrence grade 4 joints and the presence of “kissing” lesions.
Steadman JR. Ten year survivorship following knee arthroscopy in patients with moderate to severe osteoarthritis of the knee. Presented at the Arthroscopy Association of North America 2012 Annual Meeting. May 16-19. Orlando, Fla.
Disclosure: Steadman has no relevant financial disclosures.