Osteoarthritis of the knee clinical care standard indicators: 7a-Number of patients undergoing arthroscopic procedures for knee osteoarthritis

Number of patients undergoing arthroscopic procedures for knee osteoarthritis.

Several large, high-quality randomized controlled trials have failed to show any clinical benefit of arthroscopic procedures for knee osteoarthritis (Herrlin et al. 2013; Kirkley et al. 2008; Kise et al. 2016; Moseley et al. 2002). There may also be some harms related to this procedure (Thorlund et al. 2015).

45 years

Count of patients with a diagnosis of knee osteoarthritis undergoing arthroscopic procedures. Exclude from the count patients with:

• true mechanical locking
• septic arthritis.

Data from hospital information systems can be used to identify patients with knee osteoarthritis undergoing arthroscopic procedures. A chart audit is recommended for any cases identified, to assess whether these are due to errors in the data or documentation errors in the first instance. Any cases remaining following the audit should be assessed clinically to determine whether they are appropriate.

Note: Different codes may apply if the data is outside of the period 1 July 2015 to 30 June 2017.

Patients with knee osteoarthritis are those with a principal or additional diagnosis code (ICD-10-AM 9th edn.) of one of the following:

• M17.0 Primary gonarthrosis, bilateral [arthrosis of the knee]
• M17.1 Other primary gonarthrosis (includes: not otherwise specified, unilateral) [arthrosis of the knee]
• M23.2- Derangement of meniscus due to old tear or injury
• S83.2 Tear of meniscus, current.

However, exclude from the count patients with any one of the following codes as a principal or additional diagnosis coded in addition to one of the codes for osteoarthritis listed above:

• M23.8 Other internal derangements of knee (includes: laxity of ligament of knee, snapping knee)
• M00.96 Pyogenic arthritis, unspecified, lower leg (includes: infective arthritis not otherwise

Note: ‘-’ refers to the fifth character subdivision indicating the site of involvement (e.g. anterior cruciate ligament or anterior horn of medial meniscus or posterior cruciate ligament or posterior horn of medial meniscus).

Arthroscopic procedures include the following procedure codes (ACHI 9th edn.)

Presented as a number.

Number of patients with a diagnosis of knee osteoarthritis undergoing arthroscopic procedures.

This indicator has been adapted from the Osteoarthritis quality standard (NICE 2015).

N[NNN]

Applicable setting: hospital or any setting in which arthroscopic procedures are undertaken (e.g. day procedure centre).

Australian Commission on Safety and Quality in Health Care

Herrlin SV, Wange PO, Lapidus G, Hallander M, Werner S & Weidenhielm L 2013. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surgery, Sports Traumatology, Arthroscopy 21(2): 358-364.

Kirkley A et al. 2008. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine 359(11): 1097-1107.

Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L & Roos EM 2016. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ 354: i3740.

Moseley JB, O'Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH et al. 2002. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine 347(2): 81-88.

NICE (National Institute for Health and Care Excellence) 2015. Osteoarthritis Quality standard 87. London: NICE.

Thorlund JB, Juhl CB, Roos EM & Lohmander LS 2015. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ 350:h2747.