Decreasing Arthroscopy Utilization in Patients with Knee Arthritis: Quality Improvement in Orthopedics

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Efforts to identify and eliminate non-value-added care are an important part of the Triple Aim of health care reform that aims to reduce costs, improve individual health, and transform the healthcare system. Knee arthroscopy is one of the most common medical procedures performed in the United States. However, the use of arthroscopy to treat arthritis and degenerative meniscus tears has no proven patient benefit. Many factors lead to its continued use for this indication. A cohort of surgeons was evaluated for the continued prevalence of arthroscopic meniscectomy for patients with advanced knee arthritis. An initial evaluation of 378 preoperative radiographs was performed for patients who had undergone arthroscopic meniscectomy from January 1, 2018-December 31, 2018. Focusing on the surgeon driven factors, evidence-based protocols were developed and implemented. Surgeons were provided feedback on their performance through unblinded scorecards. A repeat radiologic review of 78 patients from September 1, 2019-December 31,2019 was then conducted. The average pre-operative Kellgren-Lawrence knee arthritis score decreased from 1.51 to 1.38 (p=0.58), following the intervention. Two percent of radiographs had Grade 4 arthritis during the first review and none were found on the follow-up audit. Seventeen percent of the initial cohort had moderate or severe arthritis, subsequently decreasing to 10%. The prorated annual decrease in arthroscopy for moderate and severe arthritis was 39 cases. Further follow-up is needed to understand if the change is sustainable and clinically significant, or represents sampling variation.



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