Trends in elective knee arthroscopies in a population-based cohort, 2000–2009

Megan A Bohensky, Vijaya Sundararajan, Nick Andrianopoulos, Richard N de Steiger, Andrew Bucknill, Christos M Kondogiannis, Geoffrey McColl and Caroline A Brand
Med J Aust 2012; 197 (7): 399-403. || doi: 10.5694/mja11.11645


Objective: To assess the use of elective knee arthroscopy procedures for all adults 20 years and older, and for adults with a concomitant diagnosis of osteoarthritis (OA) in Victoria.

Design, setting and patients: Retrospective, longitudinal cohort study of 807 030 elective orthopaedic admissions using routinely collected public and private hospital data from 1 July 2000 to 30 June 2009.

Main outcome measure: Trends in rates of elective knee arthroscopy in the time period (defined as a statistically significant change in the incident rate ratio for each financial year with respect to the reference year). Subgroup analyses were undertaken for patients with an associated diagnosis of OA.

Results: There were 190 881 admissions for 159 528 patients having an elective knee arthroscopic procedure. There was a significant decrease in arthroscopic procedures from the 2000–01 financial year, after adjusting for growth in elective orthopaedic volume and relevant patient and hospital characteristics. The trend did not apply to patients with osteoarthritis of the knee. A significant shift in the use of multiday procedures undertaken in high volume, public hospital settings to same-day admissions in the private sector was also identified.

Conclusions: The overall rate of elective knee arthroscopy in Victorian hospitals has decreased. There has been no sustained reduction in arthroscopy use for people with a concomitant diagnosis of OA, despite published evidence questioning the effectiveness of the procedures.

  • Megan A Bohensky1
  • Vijaya Sundararajan2
  • Nick Andrianopoulos1
  • Richard N de Steiger3,4
  • Andrew Bucknill5
  • Christos M Kondogiannis5
  • Geoffrey McColl4
  • Caroline A Brand1,5

  • 1 Centre of Research Excellence in Patient Safety, Monash University, Melbourne, VIC.
  • 2 Monash University, Melbourne, VIC.
  • 3 Epworth HealthCare, Melbourne, VIC.
  • 4 University of Melbourne, Melbourne, VIC.
  • 5 Melbourne Health, Melbourne, VIC.


Competing interests:

This study was funded by a grant from Arthritis Australia, who had no other role in it.

  • 1. Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum 1998; 41: 1343-1355.
  • 2. Laxafoss E, Jacobsen S, Gosvig KK, Sonne-Holm S. Case definitions of knee osteoarthritis in 4,151 unselected subjects: relevance for epidemiological studies: the Copenhagen Osteoarthritis Study. Skeletal Radiol 2010; 39: 859-866.
  • 3. The Royal Australian College of General Practitioners. Guideline for the non-surgical management of hip and knee osteoarthritis. South Melbourne: RACGP, 2009. http://www. (accessed Jul 2012).
  • 4. Jackson RW. Debate on the use of arthroscopic surgery for osteoarthritis of the knee. Proc (Bayl Univ Med Cent) 2003; 16: 27, discussion 28-29.
  • 5. Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347: 81-88.
  • 6. Kirkley A, Birmingham TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2008; 359: 1097-1107.
  • 7. Siparsky P, Ryzewicz M, Peterson B, Bartz R. Arthroscopic treatment of osteoarthritis of the knee: are there any evidence-based indications? Clin Orthop Relat Res 2007; 455: 107-112.
  • 8. Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C. Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev 2008; (1): CD005118.
  • 9. Chambers K, Schulzer M, Sobolev B. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. Arthroscopy 2002; 18: 683-687.
  • 10. Ilahi OA. Selection bias results in misinterpretation of randomized controlled trials on arthroscopic treatment of patients with knee osteoarthritis. Arthroscopy 2010; 26: 144-146.
  • 11. Hawker G, Guan J, Judge A, Dieppe P. Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement. J Bone Joint Surg Am 2008; 90: 2337-2345.
  • 12. Kim S, Bosque J, Meehan JP, et al. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93: 994-1000.
  • 13. Australian Bureau of Statistics. Population growth: past, present and future. Canberra: ABS, 2011. (ABS Cat. No. 4102.0.) au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+ Features10Jun+2010 (accessed Jul 2012).
  • 14. Acute Health Division, Victorian Government Department of Human Services. The Victorian Admitted Episodes Dataset: an overview. Melbourne: Victorian DHS, 2001. (accessed Jul 2012).
  • 15. Charlson ME, Sax FL, MacKenzie CR, et al. Morbidity during hospitalization: can we predict it? J Chronic Dis 1987; 40: 705-712.
  • 16. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43: 1130-1139.
  • 17. Zhang JX, Iwashyna TJ, Christakis NA. The performance of different lookback periods and sources of information for Charlson comorbidity adjustment in Medicare claims. Med Care 1999; 37: 1128-1139.
  • 18. Australian Bureau of Statistics. Census of population and housing: Socio-Economic Indexes for Areas (SEIFA), Australia – Technical paper, 2001. Canberra: ABS, 2004. (ABS Cat. No. 2039.0.55.001.) 0012001?OpenDocument (accessed Jul 2012).
  • 19. Wells VM, Hearn TC, McCaul KA, et al. Changing incidence of primary total hip arthroplasty and total knee arthroplasty for primary osteoarthritis. J Arthroplasty 2002; 17: 267-273.
  • 20. Gardner W, Mulvey EP, Shaw EC. Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models. Psychol Bull 1995; 118: 392-404.
  • 21. Tsai KJ, Chiang H, Jiang CC. Magnetic resonance imaging of anterior cruciate ligament rupture. BMC Musculoskelet Disord 2004; 5: 21.
  • 22. Australian Institute of Health and Welfare. A picture of osteoarthritis in Australia. Canberra: AIHW, 2007. (AIHW Cat. No. PHE 93; Arthritis Series No. 5.) (accessed Jul 2012).
  • 23. Australian Orthopaedic Association. National Joint Replacement Registry. Annual report. Adelaide: AOA, 2011. http://www.dmac.adelaide. (accessed Jul 2012).
  • 24. Allum R. Complications of arthroscopy of the knee. J Bone Joint Surg Br 2002; 84: 937-945.
  • 25. Jameson SS, Dowen D, James P, et al. The burden of arthroscopy of the knee: a contemporary analysis of data from the English NHS. J Bone Joint Surg Br 2011; 93: 1327-1333.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.