Does prior arthroscopic procedure impact outcomes of knee arthroplasty? A systematic review and meta-analysis

Despite generally favorable outcomes following knee arthroscopy, a certain subset of patients inevitably develops progression of knee disease, necessitating subsequent total knee arthroplasty (TKA). Therefore, the evaluation of TKA outcomes following arthroscopy has emerged as a major area of research. The aim of the current review is to measure the impact of prior arthroscopy on functional and adverse outcomes following TKA.

Literature search was conducted in the databases including Medline, EMBASE, PubMed Central, ScienceDirect, Google Scholar and Cochrane library from inception until April 2021. Meta-analysis with random-effects model was conducted to calculate pooled odds ratio (OR) or standardized mean difference (SMD) with 95% confidence interval (CI) depending on the type of outcome.

In total, 9 studies with 185,013 participants were included in the review. The majority of the studies were conducted in the USA and China. Almost all the studies had low quality as per Newcastle Ottawa (NO) scale. The pooled SMD for functional outcome was -0.19 [95%CI: -0.30 to -0.09], while the pooled OR for revision rate was 1.53 (95% CI: 1.21 to 1.92). In terms of postoperative complications, the pooled OR for stiffness was 1.55 (95% CI: 0.92-2.61), infection was 1.39 (95%CI: 1.17-1.67), aseptic loosening was 1.93 (95% CI: 1.19-3.11), VTE was 1.06 (95% CI: 0.83-1.35), and MUA was 1.33 (95% CI: 1.13-1.57) respectively.

Prior arthroscopy has significant impact on the functional and adverse clinical outcomes following TKA. Surgeons need to develop a comprehensive intervention plan to manage these high-risk patients and reduce the rate of postoperative complications.