Phua Jonathan Kia-Sheng, Razak Hamid Rahmatullah Bin Abd, Mitra Amit Kanta
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, Singapore.
J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(1):2309499020906745. doi: 10.1177/2309499020906745.
BACKGROUND/OBJECTIVE: Arthroscopic surgery in knee osteoarthritis is controversial with many studies refuting its efficacy in recent literature. This study aims to evaluate the mean duration to knee arthroplasty, and the effect of microfracture on the need for subsequent knee arthroplasty in patients above the age of 55 undergoing arthroscopic procedures for osteoarthritis.
One hundred and nine consecutive patients with diagnosed osteoarthritis who underwent arthroscopic surgery performed from January 2000 to December 2012 on patients aged 55 years and above by a single surgeon were reviewed retrospectively. Demographic data, age at operation, comorbidities, perioperative details and information of subsequent total knee arthroplasty were collected and analysed.
There were 38 males and 71 females in our study group. The group was predominantly Chinese (51.38%), with hypertension and hyperlipidaemia being the most common comorbidities, each affecting 57.8% of our study cohort. All patients had a preoperative radiograph and a magnetic resonance imaging confirming the diagnosis of osteoarthritis associated with meniscal tears. Fifty-eight knees underwent microfracture along with arthroscopic meniscectomy. The mean follow-up duration was 127.5 months (10.5 years, range: 67-212 months). Twenty three patients (20.91%) underwent knee arthroplasties subsequently, with the mean duration to arthroplasty being 65.0 months (5.5 years, range: 7-166 months). The odds ratio of avoiding knee arthroplasty with microfracture was 1.03 (95% CI = 0.410-2.581).
Arthroscopic procedures could possibly delay the need for subsequent knee arthroplasty for approximately 65 months in older patients with osteoarthritis. However, microfracture does not affect the duration between therapeutic arthroscopy and subsequent arthroplasty. Our long-term retrospective study provides an additional step in the understanding of the impact of arthroscopic procedures and a prospective case-control study would be an ideal follow-up to fully justify the application of arthroscopic procedures to delay knee arthroplasty.
背景/目的：膝关节骨关节炎的关节镜手术存在争议，近期许多研究驳斥了其疗效。本研究旨在评估55岁以上因骨关节炎接受关节镜手术的患者行膝关节置换术的平均时间，以及微骨折对后续膝关节置换术需求的影响。
回顾性分析2000年1月至2012年12月间由一名外科医生对109例55岁及以上诊断为骨关节炎的患者进行关节镜手术的连续病例。收集并分析人口统计学数据、手术年龄、合并症、围手术期细节以及后续全膝关节置换术的信息。
研究组中有38名男性和71名女性。该组以华裔为主（51.38%），高血压和高脂血症是最常见的合并症，各影响57.8%的研究队列。所有患者术前均有X线片和磁共振成像证实骨关节炎合并半月板撕裂的诊断。58个膝关节在关节镜下半月板切除术的同时进行了微骨折治疗。平均随访时间为127.5个月（10.5年，范围：67 - 212个月）。23例患者（20.91%）随后接受了膝关节置换术，置换术的平均时间为65.0个月（5.5年，范围：7 - 166个月）。微骨折避免膝关节置换术的比值比为1.03（95%可信区间 = 0.410 - 2.581）。
关节镜手术可能会使老年骨关节炎患者后续膝关节置换术的需求延迟约65个月。然而，微骨折并不影响治疗性关节镜检查与后续置换术之间的时间间隔。我们的长期回顾性研究为理解关节镜手术的影响提供了进一步的依据，前瞻性病例对照研究将是充分证明关节镜手术用于延迟膝关节置换术合理性的理想后续研究。
