Risk Factors for Early Total Knee Replacement after Ipsilateral Knee Arthroscopy in Patients over 55 Years of Age

Abstract

Arthroscopic knee surgery (AKS) is often not successful in elderly patients with osteoarthritis and degenerative meniscus tears. Many patients require subsequent total knee replacement (TKR). We performed a case-control study to identify risk factors for early TKR following AKS in patients over 55. Data were collected on patients in an integrated healthcare system who underwent AKS between January 2010 and December 2012, and then had ipsilateral total knee replacement (TKR) within one year. Controls were matched from patients who did not have TKR within one year. Of the 7,301 AKS patients, 453 (6.2%) went on to TKR. We matched 390 cases with controls (780 total subjects); 186 subjects were excluded due to inadequate radiographs or medical records resulting in a cohort of 594 patients. Statistical analysis showed that a Kellgren-Lawrence score of 3 or 4 (OR 1.9 CI 1.3-2.8, p < 0.01), age greater than 65 (OR 2.2, CI 1.5-3.2, p < 0.01), contralateral TKR (OR 2.3, CI 1.1-5.0, p < 0.04) were associated with a higher likelihood of early TKR. Sex, race, diagnosis of diabetes, prior ipsilateral knee surgery, and prior contralateral knee surgery were not associated with early TKR. When considering AKS for older patients with degenerative arthritis and meniscus tears, care providers should consider the risk of early TKR. Older patients with advanced arthritis and a diagnosis of osteoarthritis, or combined with a meniscus tear, are especially at risk for early TKR.