Sydney Orthopaedic Research Institute, Level 1, The Gallery, 445 Victoria Ave, 2067 Chatswood, NSW, Australia.
Sydney Orthopaedic Research Institute, Level 1, The Gallery, 445 Victoria Ave, 2067 Chatswood, NSW, Australia.
Knee. 2020 Oct;27(5):1476-1483. doi: 10.1016/j.knee.2020.07.004. Epub 2020 Aug 23.
Arthroscopic treatment of knee osteoarthritis has declined, in part due to concerns with conversion to arthroplasty. Some studies have investigated the demographic predictors for conversion to arthroplasty, few have assessed the risk factors within the knee itself. Our aim was to analyse the demographics and anatomical wear features of a large cohort of patients undergoing knee arthroscopy.
A retrospective analysis of 1760 cases spanning over 17 years undergoing knee arthroscopy was performed. Patients were 36 years or older at time of the index arthroscopy. Each patient received the International Cartilage Regeneration and Joint Preservation Society (ICRS) grade of all regions as well an estimate of the remaining meniscal percentage. Demographic factors as well as intraoperatively collected data were analysed as predictive variables for subsequent conversion to arthroplasty using a multi-step Cox regression analysis.
A total of 102 patients (6.2%) were converted to arthroplasty. Age at arthroscopy (hazard ratio (HR) 1.073; 95% confidence interval (CI) 1.058-1.088) and ICRS grade of the lateral tibial plateau (HR 1.166; 95% CI 1.066-1.276) were statistically significant predicting variables for conversion to arthroplasty.
The results of this study indicate that higher ICRS grade of the lateral tibial plateau at arthroscopy is the most significant predictor for conversion to knee arthroplasty, with a hazard equal to an increase in age. The absence of these factors does not justify arthroscopic treatment of patients with knee osteoarthritis.
III.
膝关节骨关节炎的关节镜治疗有所减少，部分原因是对转换为关节置换术的担忧。一些研究已经调查了转换为关节置换术的人口统计学预测因素，但很少有研究评估膝关节本身的危险因素。我们的目的是分析接受膝关节镜检查的大量患者的人口统计学和解剖学磨损特征。
对 1760 例跨越 17 年的膝关节镜检查病例进行回顾性分析。索引关节镜检查时，患者年龄为 36 岁或以上。每位患者均接受了国际软骨再生和关节保护协会（ICRS）对所有区域的分级，以及半月板剩余百分比的估计。使用多步 Cox 回归分析，将人口统计学因素以及术中收集的数据作为预测变量，分析其对随后转换为关节置换术的影响。
共有 102 例患者（6.2%）转换为关节置换术。关节镜检查时的年龄（风险比（HR）1.073；95%置信区间（CI）1.058-1.088）和外侧胫骨平台的 ICRS 分级（HR 1.166；95% CI 1.066-1.276）是转换为关节置换术的统计学显著预测变量。
这项研究的结果表明，关节镜检查时外侧胫骨平台的 ICRS 分级越高，是转换为膝关节置换术的最重要预测因素，其危害等同于年龄的增加。缺乏这些因素并不能证明对膝关节骨关节炎患者进行关节镜治疗是合理的。
III 级。
