Smith Leon, Barratt Alexandra, Buchbinder Rachelle, Harris Ian A, Doust Jenny, Bell Katy
Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.
ANZ J Surg. 2020 May;90(5):833-839. doi: 10.1111/ans.15712. Epub 2020 Feb 16.
The objective of the study is to describe temporal trends and regional variations in the use of knee magnetic resonance imaging (MRI), knee arthroscopy and total knee replacement surgery in Australians older than 55 years.
Design: A retrospective descriptive study using routinely collected administrative data.
Age-standardized rates of knee MRI, knee arthroscopy and knee replacement surgery from 2003 to 2017.
Knee MRI rates increased from 216/100 000 in 2003, to 1509/100 000 in 2017 (sevenfold relative increase). Knee arthroscopy rates initially increased from 372/100 000 in 2003 to a maximum of 475/100 000 in 2011, before declining to 283/100 000 in 2017. Knee joint replacement surgery increased from 535/100 000 in 2003 to 840/100 000 in 2017 (57% relative increase). The use of MRI increased in all regions of Australia but to differing extents. Knee arthroscopy rates declined in all regions from 2011, but to differing extents. Knee joint replacement surgery increased at roughly the same rate across Australia.
Knee arthroscopy rates increased before declining modestly in more recent years, most likely in response to evidence against its effectiveness. Knee MRI rates have continued to increase despite consistent recommendations against their routine use in the evaluation of knee pain. Future research could investigate potential drivers of the increased use of MRI, and of the continued use of arthroscopy. Further exploration of the extent to which either procedure explains the increase in numbers of knee joint replacements is also warranted.
本研究的目的是描述55岁以上澳大利亚人膝关节磁共振成像（MRI）、膝关节镜检查和全膝关节置换手术使用情况的时间趋势和地区差异。
设计：一项使用常规收集的行政数据的回顾性描述性研究。
2003年至2017年膝关节MRI、膝关节镜检查和膝关节置换手术的年龄标准化率。
膝关节MRI率从2003年的216/100 000增加到2017年的1509/100 000（相对增加了7倍）。膝关节镜检查率最初从2003年的372/100 000增加到2011年的最高值475/100 000，随后在2017年降至283/100 000。膝关节置换手术从2003年的535/100 000增加到2017年的840/100 000（相对增加57%）。MRI的使用在澳大利亚所有地区均有增加，但程度不同。膝关节镜检查率自2011年起在所有地区均有所下降，但程度不同。膝关节置换手术在澳大利亚各地的增长率大致相同。
膝关节镜检查率在近年来适度下降之前有所上升，很可能是对其有效性证据的回应。尽管一直有人建议不要在评估膝关节疼痛时常规使用膝关节MRI，但MRI率仍在持续上升。未来的研究可以调查MRI使用增加以及膝关节镜检查持续使用的潜在驱动因素。还需要进一步探讨这两种手术在多大程度上解释了膝关节置换手术数量的增加。
