Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 11, pp 2665–2671

Increasing age and female gender are associated with early knee replacement following arthroscopy

  • Simon S. Jameson
  • Stephen P. Rushton
  • Daniel Dowen
  • Paul Baker
  • Philip James
  • Mike R. Reed
  • David Deehan



Early knee replacement following arthroscopy may be perceived as a failure of the original treatment and thus a poor use of resources. Factors that may be associated with increased risk of early replacement were explored in this study.


All adult patients who underwent planned knee arthroscopy in a national cohort over a 6-month period in 2005 were extracted from the administrative hospital admissions database and linked to determine whether and when a knee replacement occurred on the same knee within the subsequent 5 years. A combination of survival analysis and mixed effect modelling was used to investigate risk factors for replacement.


There were a total of 20,556 arthroscopies, of which 2,161 (10.6 %) subsequently underwent knee replacement. For patients under 60 years, female gender (62.1 % higher risk, p < 0.001) and increasing age (12.7 % increased risk per increasing year of age, p < 0.001) were significant associations for requiring knee replacement, after risk adjusting. Of those aged ≥60, 12.7 % (576) had undergone a replacement at 1 year following arthroscopy. Females (33 % higher risk), increasing age (7.3 % increased risk per increasing year of age, p < 0.001) and hypertension (1,600 % higher risk, p < 0.001) were significant predictors. The risk associated with increased age was not proportional for the older age group, with risk declining as time passed from arthroscopy, indicating other factors were influencing progression to knee replacement.


The predictors of early knee replacement following arthroscopy were female sex, age over 60 years and hypertension, irrespective of type of operation. This work may contribute to national recommendations regarding the provision of arthroscopy for patients over 60 years.

Level of evidence



Knee arthroscopy Knee replacement Survival analysis Females 

Supplementary material

167_2013_2548_MOESM1_ESM.docx (72 kb)
Supplementary material 1 (DOCX 72 kb)


  1. 1.
    Aaron RK, Skolnick AH, Reinert SE, Ciombor DM (2006) Arthroscopic debridement for osteoarthritis of the knee. J Bone Joint Surg Am 88(5):936–943. doi:10.2106/JBJS.D.02671 PubMedCrossRefGoogle Scholar
  2. 2.
    Bays HE, Chapman RH, Grandy S (2007) The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: comparison of data from two national surveys. Int J Clin Pract 61(5):737–747. doi:10.1111/j.1742-1241.2007.01336.x PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Bernard J, Lemon M, Patterson MH (2004) Arthroscopic washout of the knee—a 5-year survival analysis. Knee 11(3):233–235. doi:10.1016/S0968-0160(03)00108-X PubMedCrossRefGoogle Scholar
  4. 4.
    Campbell SE, Campbell MK, Grimshaw JM, Walker AE (2001) A systematic review of discharge coding accuracy. J Public Health Med 23(3):205–211PubMedCrossRefGoogle Scholar
  5. 5.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRefGoogle Scholar
  6. 6.
    Connecting-for-Health (2011) Pseudonymisation implementation policy.
  7. 7.
    Dearing J, Brenkel IJ (2010) Incidence of knee arthroscopy in patients over 60 years of age in Scotland. Surgeon 8(3):144–150. doi:10.1016/j.surge.2009.11.010 PubMedCrossRefGoogle Scholar
  8. 8.
    Dervin GF, Stiell IG, Stiell IG, Rody K, Grabowski J (2003) Effect of arthroscopic debridement for osteoarthritis of the knee on health-related quality of life. J Bone Joint Surg Am 85-A(1):10–19. doi:10.1016/j.surge.2009.11.010 PubMedGoogle Scholar
  9. 9.
    Gillam MH, Salter A, Ryan P, Graves SE (2011) Different competing risks models applied to data from the Australian Orthopaedic Association National Joint Replacement Registry. Acta Orthop 82(5):513–520. doi:10.3109/17453674.2011.618918 PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Grotle M, Hagen KB, Natvig B, Dahl FA, Kvien TK (2008) Obesity and osteoarthritis in knee, hip and/or hand: an epidemiological study in the general population with 10 years follow-up. BMC Musculoskelet Disord 9:132. doi:10.1186/1471-2474-9-132 PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Hawker G, Guan J, Judge A, Dieppe P (2008) Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement. J Bone Joint Surg Am 90(11):2337–2345. doi:10.2106/JBJS.G.01671 PubMedCrossRefGoogle Scholar
  12. 12.
    Howell SM (2010) The role of arthroscopy in treating osteoarthritis of the knee in the older patient. Orthopedics 33(9):652. doi:10.3928/01477447-20100722-34 PubMedGoogle Scholar
  13. 13.
    Johanson NA, Kleinbart FA, Cerynik DL, Brey JM, Ong KL, Kurtz SM (2011) Temporal relationship between knee arthroscopy and arthroplasty: a quality measure for joint care? J Arthroplast 26(2):187–191. doi:10.1016/j.arth.2010.03.001 CrossRefGoogle Scholar
  14. 14.
    Kirkley A, Rampersaud R, Griffin S, Amendola A, Litchfield R, Fowler P (2000) Tourniquet versus no tourniquet use in routine knee arthroscopy: a prospective, double-blind, randomized clinical trial. Arthroscopy 16(2):121–126PubMedCrossRefGoogle Scholar
  15. 15.
    Krauss RM, Winston M, Fletcher BJ, Grundy SM (1998) Obesity : impact on cardiovascular disease. Circulation 98(14):1472–1476CrossRefGoogle Scholar
  16. 16.
    Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP (2002) A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 347(2):81–88. doi:10.1056/NEJMoa013259 PubMedCrossRefGoogle Scholar
  17. 17.
    Piedade SR, Pinaroli A, Servien E, Neyret P (2009) Is previous knee arthroscopy related to worse results in primary total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 17(4):328–333. doi:10.1007/s00167-008-0669-9 PubMedCrossRefGoogle Scholar
  18. 18.
    Pinheiro JC, Bates D (2000) Mixed effects models in S and S-Plus, statistics and computing. Springer, Berlin, p 528CrossRefGoogle Scholar
  19. 19.
    Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682. doi:10.1093/aje/kwq433 PubMedCrossRefGoogle Scholar
  20. 20.
    Raaijmaakers M, Vanlauwe J, Vandenneucker H, Dujardin J, Bellemans J (2010) Arthroscopy of the knee in elderly patients: cartilage lesions and their influence on short term outcome. A retrospective follow-up of 183 patients. Acta Orthop Belg 76(1):79–85PubMedGoogle Scholar
  21. 21.
    Therneau TM, Patricia G (2000) Modelling survival data, statistics for biology and health. Springer, BerlinGoogle Scholar
  22. 22.
    Upmeier HBB, Weiler A, Flamme C, Laprell H, Willich SN (2007) Follow-up costs up to 5 years after conventional treatments in patients with cartilage lesions of the knee. Knee Surg Sports Traumatol Arthrosc 15(3):249–257PubMedCrossRefGoogle Scholar
  23. 23.
    Wang Y, Simpson JA, Wluka AE, Teichtahl AJ, English DR, Giles GG, Graves S, Cicuttini FM (2009) Relationship between body adiposity measures and risk of primary knee and hip replacement for osteoarthritis: a prospective cohort study. Arthritis Res Ther 11(2):R31. doi:10.1186/ar2636 PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Simon S. Jameson
    • 4
  • Stephen P. Rushton
    • 1
  • Daniel Dowen
    • 2
  • Paul Baker
    • 2
  • Philip James
    • 3
  • Mike R. Reed
    • 4
  • David Deehan
    • 2
  1. 1.School of BiologyUniversity of NewcastleNewcastle upon TyneUK
  2. 2.Newcastle Hospitals NHS TrustNewcastle upon TyneUK
  3. 3.CHKS Healthcare Intelligence ServicesAlcesterUK
  4. 4.Northumbria Healthcare NHS Foundation TrustNorthumberlandUK

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