MENISCECTOMY BEFORE TOTAL KNEE ARTHROPLASTY INCREASES THE RISK OF ALL-CAUSE REVISION AND REVISION FOR INFECTION: A NATIONAL DATABASE ANALYSIS

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Introduction Many patients undergo total meniscectomy before undergoing total knee arthroplasty (TKA). The full impact of prior meniscectomy on TKA remains not well understood. Therefore, we aimed to compare two large TKA cohorts with and without history of meniscectomy. Methods A retrospective cohort study was conducted using the PearlDiver, national database, between 2010-2020 to identify adult patients who underwent primary unilateral TKA for osteoarthritis. Patients with <1 year of follow-up were excluded. TKA patients with a documented history of ipsilateral total meniscectomy (n=41,701) were matched 1:1 to those without such history based on age, gender, body mass index (BMI), smoking, Elixhauser comorbidity index (ECI), hypertension, diabetes mellitus, and congestive heart failure (CHF). Outcomes included 90-day emergency department (ED) visits, reoperations, readmissions, and 1- and 2-year all-cause and infection-related revision rates. All reoperations and revisions occurred on the ipsilateral side. Regression analyses were performed accounting for age, gender, ECI, smoking, and diabetes. Results In multivariate analyses, patients with a history of meniscectomy had significantly higher odds of adverse postoperative events. Compared to controls, they experienced increased 90-day ED visits (OR 1.23, p<0.001), reoperations (OR 2.10, p<0.001), and readmissions (OR 1.43, p<0.001). History of meniscectomy was also associated with increased 1-year all-cause revision (OR 2.47, p<0.001), 1-year revision for periprosthetic joint infection (PJI) (OR 2.15, p<0.001), and 1-year aseptic revision (OR 2.62, p<0.001). The elevated risk persisted at 2 years for all-cause revision (OR 2.83, p<0.001), revision for PJI (OR 2.33, p<0.001), and aseptic revisions (OR 3.06, p<0.001). Conclusion A history of total meniscectomy is associated with significantly increased risks of short- and long-term unfavorable outcomes, including ED visits, reoperations, and both septic and aseptic revisions following TKA. These findings suggest the need for heightened preoperative counseling and surveillance in this population.

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