膝关节骨关节炎管理中不必要干预的发生率：基于人群的队列研究。
The rate of unnecessary interventions for the management of knee osteoarthritis: a population-based cohort study.
机构信息
From the Faculty of Health Sciences, Western University, London, Ont. (Marsh, Birmingham); the Bone and Joint Institute, Western University, London, Ont. (Marsh, Birmingham); the Fowler Kennedy Sport Medicine Clinic, London, Ont. (Degen, Giffin, Getgood, Litchfield, Willits); the Schulich School of Medicine and Dentistry, Department of Surgery, Division of Orthopaedics, Western University, London, Ont. Giffin, Getgood, Litchfield, Willits); the Institute of Clinical Evaluative Sciences (ICES) Western, London, Ont. (McClure, Welk); and the Schulich School of Medicine and Dentistry, Department of Surgery (Urology) Western University, London, Ont. (Welk)
From the Faculty of Health Sciences, Western University, London, Ont. (Marsh, Birmingham); the Bone and Joint Institute, Western University, London, Ont. (Marsh, Birmingham); the Fowler Kennedy Sport Medicine Clinic, London, Ont. (Degen, Giffin, Getgood, Litchfield, Willits); the Schulich School of Medicine and Dentistry, Department of Surgery, Division of Orthopaedics, Western University, London, Ont. Giffin, Getgood, Litchfield, Willits); the Institute of Clinical Evaluative Sciences (ICES) Western, London, Ont. (McClure, Welk); and the Schulich School of Medicine and Dentistry, Department of Surgery (Urology) Western University, London, Ont. (Welk).
出版信息
Can J Surg. 2022 Feb 18;65(1):E114-E120. doi: 10.1503/cjs.002221. Print 2022 Jan-Feb.
BACKGROUND
Several commonly used procedures for knee osteoarthritis (OA) are not supported by evidence-based guidelines. The objective of this study was to identify the proportion of patients who underwent knee arthroscopy or magnetic resonance imaging (MRI) and the timing of these procedures before total knee arthroplasty (TKA).
METHODS
We conducted a retrospective cohort study using administrative data sets from Ontario, Canada. We identified the proportion of patients who underwent knee arthroscopy in the previous 10 years or an MRI in the 3 years before their primary TKA. We also evaluated the rate of arthroscopies by diagnosis. We report the timing of each outcome in relation to the TKA, rates by geographical area, and differences in rates over time.
RESULTS
We included 142 275 patients, of whom 36 379 (25.57%) underwent knee arthroscopy (median time 2.8 [interquartile range (IQR) 1.1-6.0] years); 22% of those were within 1 year of TKA and 52% were within 3 years. The rates of arthroscopies for a diagnosis of osteoarthritis (OA) steadily decreased, while those for meniscal-related diagnoses increased over the study period ( < 0.0001). There was significant variation by region. Of the cohort, 23.2% ( = 32 989) had an MRI before their TKA, with rates significantly increasing over time ( < 0.0001).
CONCLUSION
A substantial proportion of patients with knee OA received diagnostic and therapeutic interventions before TKA that are contrary to clinical practice guidelines.
背景
有几种常用于膝关节骨关节炎（OA）的治疗方法并没有得到循证指南的支持。本研究旨在确定接受膝关节镜检查或磁共振成像（MRI）的患者比例，以及这些手术在全膝关节置换术（TKA）之前的时间。
方法
我们使用加拿大安大略省的行政数据集进行了回顾性队列研究。我们确定了在过去 10 年内接受膝关节镜检查或在 TKA 前 3 年内接受 MRI 的患者比例。我们还评估了按诊断分类的关节镜检查率。我们报告了每种结果与 TKA 的时间关系、按地理区域的发生率以及随时间的差异。
结果
我们纳入了 142275 例患者，其中 36379 例（25.57%）接受了膝关节镜检查（中位数时间为 2.8[四分位距 1.1-6.0]年）；其中 22%在 TKA 前 1 年内，52%在 TKA 前 3 年内。OA 诊断的关节镜检查率稳步下降，而半月板相关诊断的检查率在研究期间增加（<0.0001）。不同地区之间存在显著差异。该队列中有 23.2%（=32989）在 TKA 前接受了 MRI，其比例随时间显著增加（<0.0001）。
结论
相当一部分膝关节 OA 患者在接受 TKA 之前接受了与临床实践指南相悖的诊断和治疗干预措施。
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