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The Changing Tide of Knee Arthroscopy in the U.S.

CDC data show that knee arthroscopy is one of the most frequently performed ambulatory orthopedic procedures in the United States. The surgery is now primarily used for the removal of loose bodies, debridement of meniscal tears, debridement and recontouring of cartilage flaps, arthroscopically assisted ligament reconstruction and meniscal transplantation, and synovectomy. In the early 1980s, there was a shift toward performing some surgical procedures on an outpatient basis for a variety of reasons. “Advances in anesthesia and surgical techniques, financial incentives to providers and patients, and enhancements in postoperative pain management were all factors that led to this shift,” explains Richard A. Marder, MD. “It’s well understood that the number of ambulatory surgical procedures is increasing, but there has been little study exploring the frequency and magnitude of these procedures occurring in outpatient settings in the U.S.” Significant 10-Year Trends In the June 1, 2011 Journal of Bone and Joint Surgery, Sunny H. Kim, PhD, Jose Bosque, MD, John P. Meehan, MD, Amir Jamali, MD, and Dr. Marder had a study published that described the changes in demographics and utilization of knee arthroscopy in ambulatory settings between 1996 and 2006 in the U.S. The investigation, which analyzed CDC data from the National Survey of Ambulatory Surgery, also sought out to determine the most common reasons for knee arthroscopy over the past decade. “Our analysis revealed several interesting trends,” says Dr. Marder. “First, between 1996 and 2006, the number of knee arthroscopies increased by 49% (Table 1). The increase in knee arthroscopy procedures was much steeper than the growth of the U.S. population during the same period.” “Clinicians should continue to...

Conference Highlights: The American Academy of Orthopaedic Surgeons 2011

This feature highlights some of the studies that emerged from the 2011 AAOS annual meeting, including data supporting the long-term function of total knee replacement (TKR), imaging costs linked to defensive medicine, PE risks after knee arthroplasty, and the effect of stretching before running. » TKR Improves Function for the Long-Term » PE Risks After Knee Arthroplasty » Are Two TKRs Better Than One? » The Effects of Stretching Before Running » Imaging Costs Linked to Defensive Medicine TKR Improves Function for the Long Term The Particulars: Most patients who undergo total knee replacement (TKR) are between the ages of 60 and 80. More than 90% of these individuals experience a dramatic reduction in knee pain and a significant improvement in their ability to perform common activities. However, questions have been raised about the decline in physical function over the long term despite the absence of implant-related problems. Data Breakdown: Between 1975 and 1989, a study looked at TKRs performed in 128 patients who were living at 20 years follow-up. The average age at operation was 63.8. Of the study participants, 95 could walk at least five blocks when assessed at 20 years follow-up, and 48% reported unlimited walking ability. All but two patients could negotiate up and down stairs without a banister. Only three patients were considered housebound, and no implant failures were observed after 20 years. Take Home Pearls: Elderly recipients of TKR appear to be using their surgically replaced knees for fairly active lifestyles many years after surgery. This study refutes the perception that well-functioning TKRs diminish over time because of an overall declining functional status. PE Risks After...
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