COMPLICATION RATES IN KNEE AND SHOULDER ARTHROSCOPY

Participants: E.M. Wojtys, M.B. Brown, J.M. Hall

Keywords: arthroscopy, surgical complications, adverse events, complication incidence

Introduction

Arthroscopic surgery is a rapidly developing technique in orthopaedic surgery. Over the past 15 years, arthroscopic techniques have revolutionized the treatment of shoulder and knee injuries, improving clinical care and reducing the morbidity of knee and shoulder surgery. Most graduates of American orthopaedic residency training programs will be capable of performing arthroscopic techniques or will seek fellowship training that will improve their abilities to perform these techniques. Because of the developing nature of arthroscopic surgery, there is an immediate need to educate those practicing and learning these techniques about the complications that are possible.

While some complications are common to both open and arthroscopic techniques, some are unique to arthroscopy. Consequently, there is a significant need to identify the factors associated with complications following arthroscopy, and to educate the orthopaedic community about these factors. Inexperienced surgeons need to know the types and expected incidence of potential problems, while practicing surgeons need a benchmark by which to judge their own work.

The principal objectives of this study are to: 1) estimate the rates of knee and shoulder arthroscopy complications overall, and in different types of surgical practices; and 2) identify potential factors associated with these complications.

Results of this research may be used to develop improved surgical training programs and/or continuing medical education programs, which could help to reduce the arthroscopic surgery complication rate.

Materials and Methods

The sample frame, consisting of approximately 3,500 orthopaedic clinical practices, will be randomized by size and geographic location. Sites will be invited to participate according to the randomization scheme until approximately 40 sites are enrolled. Five thousand patients (2500 knee and 2500 shoulder) undergoing arthroscopy at these sites will be enrolled in the study. Surgeons and/or clinical staff at participating sites will complete standardized forms that collect specific demographic and clinical data pertaining to: 1) the arthroscopic procedure, 2) general medical status, and 3) post-operative follow-up visits of enrolled subjects. Information on the participating surgeons will also be collected, including age, arthroscopic training and experience, type of practice (e.g. whether academically affiliated or nonaffiliated private practice), and type of surgical facility (e.g. hospital based or free-standing surgical center). The overall complication rates for knee and shoulder arthroscopy will be calculated. Analysis of potential contributing patient-related and surgeon-related factors will also be conducted, providing that the subgroups being analyzed are sufficiently large to detect clinically meaningful differences.

Progress

IRB approval has been obtained for this study and the sample frame has been randomized by practice size and geographic location. Initial contact letters have been mailed to the first 25 randomized sites and follow-up calls will begin shortly.