OBJECTIVE: The aim of this study was to determine the proportion of patients undergoing arthroscopic partial meniscectomy (APM) then subsequently receiving a knee arthroplasty within 1 or 2 years, with focus on patients over the age of 60 years and regional variation.
METHODS: Patients undergoing APM in England over 20-years (01-April-1997 to 31-March 2017) were identified in the national Hospital Episode Statistics (HES). The proportion of patients undergoing arthroplasty in the same knee within 1 or 2 years of APM was determined and trends were analysed over time nationally and by NHS Clinical Commissioning Group (CCG) region.
RESULTS: 806,195 APM patients were eligible for analysis with at least 1-year of follow up and 746,630 with 2-years. The odds of arthroplasty conversion within 1 year increased over the study period (odds ratio [OR] 3.10 within 1-year in 2014 vs 2000; 95% confidence interval [CI] 2.75-3.50). For patients undergoing APM aged 60 years or older in 2015-16, 9.9% (1689/17,043; 95% CI 9.5-10.4) underwent arthroplasty within 1-year and, in 2014-15, 16.6% (3100/18,734; 95% CI 16.0-17.1) underwent arthroplasty within 2-years. There was greater than 10-fold variation by CCG.
CONCLUSIONS: Over the study period, the proportion of patients undergoing arthroplasty within 1-year of APM increased. In 2015-16, of patients aged 60 years or older who underwent APM, 10% subsequently underwent knee arthroplasty within 1 year (17% within 2 years in 2014-15) and there was a high level of regional variation in this outcome. The development and adoption of national treatment guidance is recommended to improve and standardise treatment selection.