P149 - Chondroplasty in Patients with OA is Associated with a Decreased Rate of TKA: A Large Matched Insurance Database Cohort Analysis
Abstract
Purpose
Previous studies have criticized the benefit of conducting a meniscectomy in patients with osteoarthritis (OA). This study sought to identify whether patients with a meniscectomy with or without chondroplasty differed in rates of conversion to TKA and time to TKA.
Methods and Materials
A large insurance database was queried for patients who had a CPT code for meniscectomy between 2015 and 2018 with at least 2 years of follow-up. The study population was stratified into groups depending on whether a chondroplasty was performed and whether the patient had a diagnosis of ipsilateral knee osteoarthritis (OA). Groups were matched on age, gender, Charlson Comorbidity Index (CCI), and comorbidities. Patients with rheumatoid arthritis at time of meniscectomy were excluded. The primary outcome was subsequent TKA during follow-up. Other outcomes included complication and readmission rates. Predictors of TKA were modeled using multivariable logistic regression.
Results
The final analysis consisted of 5,356 patients, 1,339 per group. Demographics did not vary by group after matching. Of patients without OA, 6 patients (0.4%) without chondroplasty and 8 (0.6%) with chondroplasty had a TKA. Among patients with OA, 166 patients (12.4%) without chondroplasty and 210 patients (15.7%) with chondroplasty had TKA (P<0.0001). Positive predictors of a TKA included older age (adj-OR = 1.030, 95% CI = 1.018-1.044, P<0.001), chondroplasty (adj-OR = 1.368, 95% CI 1.102-1.702, P=0.005), obesity (adj-OR = 1.541, 95% CI 1.229=1.937, P<0.001), and ipsilateral knee OA (adj-OR 31.743, 95% CI 19.306-56.971, P<0.001). Male gender (adj-OR = 0.914, 95% CI 0.728-1.145, P=0.436) and increasing CCI (adj-OR 1.124, 95% CI 1.004-1.234, P=0.038) were not significant predictors of a subsequent TKA.
Conclusion
In patients with a meniscus tear and OA, chondroplasty appears be associated with higher TKA rates but lower complication rates. Patients with older age, obesity, chondroplasty, and OA are most likely to have a TKA within 5 years of a meniscectomy.
