Skip to main content
SpringerLink
Log in

ARthroscopy in Knee OsteoArthritis (ARK-OA): a multicentre study assessing compliance to national guidelines

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The use of arthroscopy to alleviate the symptoms of osteoarthritis has been questioned by recent high quality evidence. This has led to the development of guidelines by specialist and national bodies advocating against its use.

Aims

To examine the trends of the rates of arthroscopy in patients with knee osteoarthritis over the past five years and determining compliance with guidelines.

Methods

Multi-centre, retrospective audit in five hospital trusts in the United Kingdom. The number of arthroscopies performed by month from 2013 to 2017 was identified through hospital coding. Fifty randomly selected records from the year 2017 were further analysed to assess compliance with NICE guidelines.

Results

Between 2013 and 2017, the number of arthroscopies performed annually in five trusts dropped from 2028 to 1099. In the year 2017, 17.7% of patients with no mechanical symptoms and moderate-to-severe arthritis pre-operatively had arthroscopy.

Conclusion

Knee arthroscopy continues to be used as a treatment for osteoarthritis, against national guidelines. Whilst overall numbers are declining, further interventions, including implementation of high-quality conservative care is required to further eliminate unnecessary procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Felson DT (2006) Clinical practice. Osteoarthritis of the knee. N Engl J Med 354(8):841–8

    Article  CAS  Google Scholar 

  2. Mahir L et al (2016) Impact of knee osteoarthritis on the quality of life. Ann Phys Rehabilit med 59:e159

    Article  Google Scholar 

  3. McGrory B et al (2016) The American academy of orthopaedic surgeons evidence-based clinical practice guideline on surgical management of osteoarthritis of the knee. J Bone Joint Surg Am 98(8):688–692

    Article  Google Scholar 

  4. Carr A (2015) Arthroscopic surgery for degenerative knee. Bmj 350:h2983

    Article  Google Scholar 

  5. Cullen KA, Hall MJ, Golosinskiy A (2009) Ambulatory surgery in the United States, 2006. Natl Health Stat Report 11:1–25

    Google Scholar 

  6. Owings MF, Kozak LJ (1998) Ambulatory and inpatient procedures in the United States. Vital Health Stat 13(139):1–119

    Google Scholar 

  7. Chen A et al (2012) The Global economic cost of osteoarthritis: how the UK compares. Arthritis 2012:698709

    Article  CAS  Google Scholar 

  8. Chang RW et al (1993) A randomized, controlled trial of arthroscopic surgery versus closed-needle joint lavage for patients with osteoarthritis of the knee. Arthritis Rheum 36(3):289–296

    Article  CAS  Google Scholar 

  9. Harwin SF (1999) Arthroscopic debridement for osteoarthritis of the knee: predictors of patient satisfaction. Arthroscopy 15(2):142–146

    Article  CAS  Google Scholar 

  10. Livesley PJ et al (1991) Arthroscopic lavage of osteoarthritic knees. J Bone Joint Surg Br 73(6):922–926

    Article  CAS  Google Scholar 

  11. Brignardello-Petersen R et al (2017) Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open 7(5):e016114

    Article  Google Scholar 

  12. Khan M et al (2014) Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ 186(14):1057–1064

    Article  Google Scholar 

  13. Kirkley A et al (2008) A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 359(11):1097–1107

    Article  CAS  Google Scholar 

  14. Moseley JB et al (2002) A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 347(2):81–88

    Article  Google Scholar 

  15. Thorlund JB et al (2015) Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ 350:h2747

    Article  CAS  Google Scholar 

  16. National Institute for Clinical Excellence (2014) Clinical guideline [CG177]: Osteoarthritis: care and management. https://www.nice.org.uk/guidance/cg177.

  17. Barlow T, Plant CE (2015) Why we still perform arthroscopy in knee osteoarthritis: a multi-methods study. BMC Musculoskelet Disord 16:85

    Article  Google Scholar 

  18. Beaufils P et al (2017) Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Joints 5(2):59–69

    Article  CAS  Google Scholar 

  19. Digital N (2019) Hospital Episode Statistics; Available from: http://content.digital.nhs.uk/hes.

  20. Siemieniuk RAC et al (2017) Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 357:j1982

    Article  Google Scholar 

  21. Abram SGF et al (2019) Temporal trends and regional variation in the rate of arthroscopic knee surgery in England analysis of over 1.7 million procedures between 1997 and 2017. Has practice changed in response to new evidence? Br J Sports Med 53(24):1533–1538

    Article  Google Scholar 

  22. Jackson RW, Dieterichs C (2003) The results of arthroscopic lavage and debridement of osteoarthritic knees based on the severity of degeneration: a 4- to 6-year symptomatic follow-up. Arthroscopy 19(1):13–20

    Article  Google Scholar 

  23. Abram SGF et al (2019) Arthroscopic partial meniscectomy for meniscal tears of the knee: a systematic review and meta-analysis. Br J Sports Med. 54(11):625–663

    Google Scholar 

  24. Comstock BA et al (2013) Investigational vertebroplasty safety and efficacy trial (INVEST): patient-reported outcomes through 1 year. Radiology 269(1):224–231

    Article  Google Scholar 

  25. Luetmer MT, Kallmes DF (2011) Have referral patterns for vertebroplasty changed since publication of the placebo-controlled trials? AJNR Am J Neuroradiol 32(4):647–648

    Article  CAS  Google Scholar 

  26. Abram SGF et al (2018) Adverse outcomes after arthroscopic partial meniscectomy: a study of 700 000 procedures in the national hospital episode statistics database for England. Lancet 392(10160):2194–2202

    Article  Google Scholar 

  27. Prasad V, Cifu A, Ioannidis JP (2012) Reversals of established medical practices: evidence to abandon ship. JAMA 307(1):37–38

    Article  CAS  Google Scholar 

  28. Campbell SE et al (2001) A systematic review of discharge coding accuracy. J Public Health Med 23(3):205–211

    Article  CAS  Google Scholar 

  29. Barlow T et al (2020) Decreasing the number of arthroscopies in knee osteoarthritis – a service evaluation of a de-implementation strategy. BMC Musculoskelet Disord 21(1):140

    Article  Google Scholar 

Download references

Funding

The authors did not receive support from any organisation for the submitted work.

Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK

    Chetan Khatri, Edward Dickenson, Imran Ahmed, Christopher Downham, Damir Rasidovic & Timothy Barlow

  2. Milton Keynes University Hospital, Milton Keynes, UK

    Chris Bretherton & Tom Ranaboldo

  3. North Cumbria Integrated Care NHS Foundation, Carlisle, UK

    Colin Shaw & Jared Quarcoopome

  4. Lancashire Teaching Hospital Trust, Preston, UK

    Ricci Plastow

  5. South Warwickshire Foundation Trust, Warwick, UK

    Caroline Plant

Authors
  1. Chetan Khatri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edward Dickenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Imran Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chris Bretherton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tom Ranaboldo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Colin Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jared Quarcoopome
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ricci Plastow
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christopher Downham
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Damir Rasidovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Caroline Plant
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Timothy Barlow
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. All authors performed material preparation, data collection. Chetan Khatri wrote the first draft of the manuscript and performed study analysis. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Timothy Barlow.

Ethics declarations

Conflict of interest

The authors declare no conflicting interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khatri, C., Dickenson, E., Ahmed, I. et al. ARthroscopy in Knee OsteoArthritis (ARK-OA): a multicentre study assessing compliance to national guidelines. Eur J Orthop Surg Traumatol 31, 1443–1449 (2021). https://doi.org/10.1007/s00590-021-02905-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-021-02905-5

Keywords

Search

Navigation