Trends in utilization: has extremity MR imaging replaced diagnostic arthroscopy?

Area of Science:

• Orthopedic Surgery
• Radiology
• Health Services Research

Background:

• Arthroscopy and magnetic resonance (MR) imaging are key diagnostic and therapeutic tools in extremity medicine.
• Understanding trends in their utilization is crucial for resource allocation and clinical practice evaluation.

Purpose of the Study:

• To compare the changes in utilization rates of extremity MR imaging versus diagnostic and therapeutic arthroscopy.
• To analyze these trends over time and across different geographic regions.

Main Methods:

• Utilized nationwide Medicare Part B databases from 1993, 1996, and 1999.
• Calculated utilization rates per 100,000 for extremity MR imaging, diagnostic arthroscopy, and therapeutic arthroscopy using CPT-4 codes.
• Compared utilization across 10 US geographic regions and tracked changes over the study period.

Main Results:

• Extremity MR imaging utilization surged by 168.7% (393 to 1056 per 100,000) from 1993 to 1999.
• Diagnostic arthroscopy rates decreased significantly (e.g., knee -54.5%, shoulder -71.4%).
• Therapeutic arthroscopy utilization increased (e.g., overall +40.0%, shoulder +136.4%), while MR imaging for lower extremities rose 144.8% and upper extremities 221.1%.

Conclusions:

• Extremity MR imaging utilization markedly increased between 1993 and 1999.
• Diagnostic arthroscopy utilization decreased, while therapeutic arthroscopy utilization increased during the same period.
• Findings suggest a growing reliance on MR imaging for preoperative decision-making in extremity conditions.