RevisionRatesofKneeCartilageRestorationSurgeriesandConversiontoTotalKneeArthroplastyWithinFiveYearsRavand Khazai MD,Harout Boyajian MD,Olumuyiwa Idowu,LewisShiMD,Aravind Athiviraham,MD
UniversityofChicago,DepartmentofOrthopaedicSurgeryandRehabilitationMedicine
Conclusion
Objectives
ResultsIntroduction
Materials & Methods
• To examine the rates of complications and re-operation for common knee cartilage reconstruction procedures performed in the United States, and subsequent conversion to total knee arthroplasty (TKA).
• Previous studies have examined outcomes of osteoarthritis patients, as well as rates of conversion to total joint arthroplasty following general knee arthroscopy.
• Few studies have examined outcomes or conversion rates for patients who have undergone specific cartilage restoration procedures.
• Institutional Review Board approval obtained • Retrospective review of the Truven Health
Marketscan® Research Database (de-identified records for 55 million US patients with private or employer provided coverage)
• Microfracture and OATS are associated with lower rates of conversion to TKA within 5 years compared to previous reports for general knee arthroscopic procedures.
• Patients undergoing ACI were more likely to require a subsequent surgical procedure or conversion to arthroplasty, while those undergoing microfracture were least likely.
Revision Surgery Codes
Inclusion Criteria• Patients treated between 2003 and 2014, tracked at
least 2 years post primary operation for revision/complication data and 5 years for TKA data
• Microfracture/abrasion chondroplasty (CPT 29879), osteochondral auto- or allo- grafting (OATS) (CPT 27415, 27416, 29866, 29867), and autologous chondrocyte implantation (ACI) (CPT 27412).
• For TKA conversion, age limited to >50.
Complication Codes
CPT Definition
27415 Osteochondralallograft,knee,open
27416 Osteochondralautograft,knee,open
29846 Arthroscopywithdebridement
29867 ArthroscopicOsteochondralAllograft
27412 AutologousChondrocyteImplantation
29879 Microfracture/Abrasionarthroplasty
29877 Chondroplasty/Debridement
CPT Definition27301 Incision&drainage,deepabscess,bursa,hematoma27303 Incision&drainage,withinvolvementofbone27310 Arthrotomy,knee,withexploration,drainage,orremovalof
foreignbody27520 Closedtreatmentofpatellarfracture,withoutmanipulation27524 Opentreatmentofpatellarfracture,withinternalfixation27570 Manipulationofkneejointundergeneralanesthesia29871 Arthroscopy,knee,surgical;forinfection,lavageanddrainage
29884 Arthroscopy,knee,surgical;withlysisofadhesions,withorwithoutmanipulation
• Microfracture▲- most common -76,304 patients• Incidence decreased every year starting in 2009, from
approximately 600 cases per million in 2009, to approximately 450 per million in 2014.
• OATS ♦, relatively stable incidence of between 2009-2014, with 20-25 cases per year per million.
• 2,151 patients were enrolled throughout the encompassed time period.
• ACI ◼ was the least common, 868 patients enrolled
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Figure1.INCIDENCEOFCARTILAGERESTORATIONSURGERY2003-2014
• Patients s/p microfracture tended to be older than those who underwent either osteochondral grafting or ACI, with an average age of 48.3 years (p < .001).
• No statistically significant difference between OATS and ACI (average 34.5 years for both).
Microfracture OATS ACItotaln 76,304 2,151 868MeanAge 48.3(SD13.6) 34.5(SD14.1) 34.5(SD13.5)Adolescents(10-19)
4,184(5.5%) 491(22.8%) 168(19.4%)
Youngadults(20-34)
6,738(8.8%) 550(25.6%) 263(30.3%)
Adults(>35) 65,371(85.7%) 1,110(51.6%) 437(50.3%)males 38,084(49.9%) 1,230(57.2%) 451(52%)females 38,220(50.1%) 921(42.8%) 417(48%)
TABLE 1. DEMOGRAPHIC INFORMATION
Microfracture OATS ACI
nat2y 76,304 2,151 868nat5y 24,892 741 233Rateofrevision 6,403(8.4%)* 331(15.4%) 183(21.1%)Mostcommonrevision
revisionmicrofracture(57.1%)
chondroplasty(52.6%)
chondroplasty(63.5%)
Ndaystorevision 349 272 370Rateofcomplication 1,065(1.4%)* 107patients(5%) 46(2.1%)
Mostcommoncomplication
manipulationunderanesthesia(49.8%)
lysisofadhesions(43.3%)
lysisofadhesions(61%)
#ofTKAwithin5y 428(1.7%) 16(2.2%) 16(6.9%)*MeandaystoTKA 780 918 867Meanage 48.3y* 34.5y 34.5yMeanageofTKApts 56.2y 48.9y 49.2y* indicates significant difference among row (p < 0.01)
TABLE 2. RATES OF FOLLOW UP, REVISION, COMPLICATION, AND ARTHROPLASTY FOLLOWING CARTILAGE RESTORATION PROCEDURES
• Microfracture patients, 6,403 (8.4%) underwent at least one revision surgery• microfracture (4,383; 57.1%), chondroplasty (2,815; 36.7%),
and open osteochondral grafting (173; 2.3%).
• 1,065 (1.4%) patients sustained a complication • manipulation under anesthesia (MUA) (626; 49.8%),
arthroscopic lysis of adhesions (LOA) (341; 27.1%), arthroscopic lavage and drainage (I&D) (130, 10.3%), and incision and drainage (68, 5.4%).
• OATS: 331 (15.4%) underwent at least one revision procedure• chondroplasty (229; 52.6%), microfracture (98, 22.5%), and
open OATS (50, 11.5%).
• 107 patients (5%) sustained a complication• LOA (55; 43.3%), MUA (47; 37.0%), open I&D (9; 7.1%), and
arthroscopic I&D (7; 5.5%).
• ACI was the least common; 868 patients• 183 (21.1%) underwent revision surgeries
• chondroplasty (151; 63.5%), revision ACI (44, 18.5%), and microfracture (36, 15.1%) were most commonly performed.
• 46 (2.1%) patients sustained a complication • LOA (36; 61%) and MUA (22; 37.3%).
Microfracture OATS ACI
nat5y 13,236 115 25
#ofTKAwithin5y 308(2.3%)* 5(4.3%) 6(24%)
MeandaystoTKA 731 893 532*
TABLE 3. RATES OF ARTHROPLASTY FOLLOWING CARTILAGE RESTORATION PROCEDURES IN PATIENTS OLDER THAN 50 YEARS
• 13,236 Microfracture patients (age >50) remained enrolled for 5 years • 308 (2.3%) underwent TKA at an average 731 days
(2.1 years) • OATS cohort, 115 patients (age >50) remained
enrolled for 5 years • 5 patients (4.3%) underwent TKA at an average of
893 days • Of the ACI cohort, 25 patients (age>50) remained
enrolled for 5 years • 6 (24%) underwent TKA at an average of 532 days
* indicates significant difference among row (p < 0.01)
