Atrium Health Musculoskeletal Institute, Charlotte, North Carolina.
OrthoCarolina Research Institute, Charlotte, North Carolina.
J Knee Surg. 2023 May;36(6):591-595. doi: 10.1055/s-0041-1740391. Epub 2021 Dec 7.
The purpose of this study was to evaluate the conversion rate of knee arthroscopy to ipsilateral total knee arthroplasty (TKA) within 2 years in patients aged 50 or older at the time of arthroscopy. The administrative database from a large, physician-owned orthopaedic practice (>100 surgeons) was queried to identify patients over the age of 50 who had undergone arthroscopic knee surgery between January 1, 2006 and January 2, 2015. The subset of patients who converted to TKA within 2 years after knee arthroscopy was identified and matched by age and sex to a control population that did not convert to TKA. Rates of conversion to TKA were calculated. Prearthroscopic digital radiographs were reviewed and Kellgren-Lawrence (KL) grades were compared among case and control populations. Univariable analyses and multivariable regression analysis were performed. Eight hundred seven of 16,061 (5.02%) patients aged 50 or older were converted to TKA within 2 years following ipsilateral knee arthroscopy. In univariable analysis, the rate of conversion to TKA in patients aged between 50 and 54 was 2.94%, compared with 4.44% in patients aged between 55 and 64, and 8.32% in patients 65 or older ( < 0.0001). Female sex was associated with a higher rate of conversion to TKA in univariable analysis (5.93 vs. 4.02% in males, < 0.0001). KL grades were higher among patients who converted to TKA compared with those who did not ( < 0.0001). In a multivariable regression model controlling for age, sex, and KL grade, only increased KL grade was associated with increased odds of conversion to TKA. In the appropriately selected older patient, the risk of conversion to TKA within 2 years of knee arthroscopy is low (∼5%). Patients with KL grade 2 or higher at the time of arthroscopy should be counseled on the increased odds of early conversion to TKA.
本研究旨在评估在关节镜检查时年龄为 50 岁或以上的患者，在 2 年内将膝关节镜检查转为同侧全膝关节置换术（TKA）的转化率。从一家大型、医生所有的骨科实践的管理数据库（>100 名外科医生）中查询了年龄在 50 岁以上的患者，他们在 2006 年 1 月 1 日至 2015 年 1 月 2 日期间接受了膝关节镜手术。确定了在膝关节镜检查后 2 年内转为 TKA 的患者亚组，并按年龄和性别与未转为 TKA 的对照组相匹配。计算了转为 TKA 的比率。对术前数字 X 光片进行了回顾，并比较了病例组和对照组的 Kellgren-Lawrence（KL）分级。进行了单变量分析和多变量回归分析。在 16061 名年龄在 50 岁或以上的患者中，有 807 名（5.02%）在同侧膝关节镜检查后 2 年内转为 TKA。在单变量分析中，年龄在 50-54 岁之间的患者转为 TKA 的比率为 2.94%，年龄在 55-64 岁之间的患者为 4.44%，年龄在 65 岁或以上的患者为 8.32%（<0.0001）。单变量分析显示，女性转为 TKA 的比率高于男性（女性为 5.93%，男性为 4.02%，<0.0001）。与未转为 TKA 的患者相比，转为 TKA 的患者 KL 分级更高（<0.0001）。在控制年龄、性别和 KL 分级的多变量回归模型中，只有 KL 分级升高与转为 TKA 的几率增加相关。在适当选择的老年患者中，膝关节镜检查后 2 年内转为 TKA 的风险较低（约 5%）。在关节镜检查时 KL 分级为 2 级或以上的患者应告知其早期转为 TKA 的几率增加。
