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Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to determine the cost of arthroscopic partial meniscectomy (APM), one of the most common surgeries performed by orthopaedic surgeons, and the associated rate of progression to knee arthroplasty (KA) compared to patients treated non-operatively after diagnosis of meniscal tear.

Methods

Utilizing data mining software (PearlDiver, Colorado Springs, CO), a national insurance database of approximately 23.5 million orthopaedic patients was queried for patients diagnosed with a meniscal tear. Patients were classified by treatment: non-operative and arthroscopic partial meniscectomy and were followed after initial diagnosis for cost and progression to knee arthroplasty.

Results

There were 176,407 subjects in the non-op group and 114,194 subjects in the arthroscopic partial meniscectomy group. Arthroscopic partial meniscectomy generated more cost than non-operative ($3842.57 versus $411.05, P < 0.001). Arthroscopic partial meniscectomy demonstrated greater propensity to need future knee arthroplasty (11.4% at 676 days) than those treated non-operatively (9.5% at 402 days) (P < 0.001). Female patients demonstrated a higher rate of progression to knee arthroplasty in the arthroscopic partial meniscectomy and non-operative groups (P < 0.001).

Conclusion

Compared to non-operative treatment for meniscal tears, arthroscopic partial meniscectomy is more expensive and does not appear to decrease the rate of progression to knee arthroplasty. Patients undergoing arthroscopic partial meniscectomy yielded on average a delay of only 9 months (274 days) before undergoing knee arthroplasty. Female patients experienced a significantly higher rate of progression to knee arthroplasty. The authors recognize the limitations of this type of study including its retrospective nature, reliance upon accurate coding and billing information, and the inability to determine whether symptoms including mechanical locking played a role in the decision to perform an APM.

Level of evidence

IV.

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Abbreviations

OA:

Knee osteoarthritis

BMI:

Body mass index

PT:

Physical therapy

APM:

Arthroscopic partial meniscectomies

ICD:

International classification of diseases

CPT:

Current procedural terminology

TKA:

Total knee arthroplasties

KA:

Knee arthroplasty

RCT:

Randomized controlled trial

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Funding

Funding was provided by the Department of Orthopedics at The University of Kansas Medical Center, no outside funding was used.

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Authors and Affiliations

  1. Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA

    Brandon Barnds, Brandon Morris, Scott Mullen, John Paul Schroeppel, Armin Tarakemeh & Bryan G. Vopat

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  1. Brandon Barnds
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  2. Brandon Morris
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  3. Scott Mullen
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Contributions

BB: primary author and orthopaedic resident responsible for all aspects of study and manuscript. BM: co-author and orthopaedic resident responsible for background, study design, analysis, and review. AT: co-author and orthopaedic research assistant responsible for database management, analysis, and review. JPS: co-author and orthopaedic attending responsible for background, study design, analysis, and review. SM: co-author and orthopaedic attending responsible for background, study design, analysis, and review. BV: primary investigator and orthopaedic attending responsible for background, study design, analysis, and review.

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Correspondence to Brandon Barnds.

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None of the authors have any relevant conflicts of interest pertaining to this research.

Ethical approval

This study was approved by the Institutional Review Board at The University of Kansas Medical Center.

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Supplementary material 1 (DOCX 25 KB)

167_2019_5481_MOESM2_ESM.tif

Supplemental Figure 1: Kaplan-Meier survival analysis illustrating the ratio of patients within each treatment group that did not require KA, and the number of days since initial diagnosis of meniscal tear to KA. (TIF 23 KB)

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Barnds, B., Morris, B., Mullen, S. et al. Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management. Knee Surg Sports Traumatol Arthrosc 27, 2316–2321 (2019). https://doi.org/10.1007/s00167-019-05481-8

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