Skip to main content

Advertisement

SpringerLink
Log in

MRI use leading up to total knee arthroplasty: a retrospective cohort study

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Demand for total knee arthroplasty (TKA) is increasing as it remains the gold-standard treatment for end-stage osteoarthritis (OA) of the knee. Magnetic resonance imaging (MRI) scans of the knee are not indicated for diagnosing knee OA and represent a possible delay to orthopaedic surgeon referral and unnecessary expenditure. The purpose of this study was to determine the proportion of patients who underwent an MRI in the two years prior to their primary TKA for OA and determine patient and physician associations with increased MRI usage.

Methods

This is a population-based cohort study using administrative data from Ontario, Canada. All patients over 40 years old who underwent their first primary TKA between April 1, 2008, and March 31, 2019, were included. Statistical analyses were performed using SAS and included the Cochran–Armitage test for trend of MRI prior to surgery. A predictive multivariable regression model was used to determine features correlated to receiving an MRI.

Results

There were 194,989 eligible first-time TKA recipients, of which 38,244 (19.6%) received an MRI in the two years prior to their surgery. The majority of these (69.6%) were ordered by primary care physicians. Patients who received an MRI were younger, had fewer comorbidities and were more affluent than patients who did not (p < 0.001). MRI use prior to TKA increased from 2008 to 2018 (p < 0.001).

Conclusion

Despite MRIs rarely being indicated for the work-up of end-stage OA, nearly one in five patients have an MRI in the two years prior to their TKA. This may be increasing healthcare expenditure and surgical wait-times.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lau RL, Gandhi R, Mahomed S, Mahomed N (2012) Patient satisfaction after total knee and hip arthroplasty. Clin Geriatr Med 28(3):349–365

    Article  PubMed  Google Scholar 

  2. Hayashi D, Roemer FW, Guermazi A (2016) Imaging for osteoarthritis. Ann Phys Rehabil Med 59(3):161–169

    Article  CAS  PubMed  Google Scholar 

  3. Osteoarthritis in over 16s (2022) diagnosis and management. United Kingdom: National Institute for Health and Care Excellence

  4. Hayashi D, Roemer FW, Guermazi A (2019) Magnetic resonance imaging assessment of knee osteoarthritis: current and developing new concepts and techniques. Clin Exp Rheumatol 37(Suppl 1):88–95

    PubMed  Google Scholar 

  5. Sherman SL, Gulbrandsen TR, Lewis HA, Gregory MH, Capito NM, Gray AD et al (2018) Overuse of magnetic resonance imaging in the diagnosis and treatment of moderate to severe osteoarthritis. Iowa Orthop J 38:33–37

    PubMed  PubMed Central  Google Scholar 

  6. Brealey SD, Team DT (2007) Influence of magnetic resonance of the knee on GPs’ decisions: a randomised trial. Br J Gen Pract 57(541):622–629

    PubMed  Google Scholar 

  7. Menashe L, Hirko K, Losina E, Kloppenburg M, Zhang W, Li L et al (2012) The diagnostic performance of MRI in osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil 20(1):13–21

    Article  CAS  Google Scholar 

  8. Sakellariou G, Conaghan PG, Zhang W, Bijlsma JWJ, Boyesen P, D’Agostino MA et al (2017) EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis 76(9):1484–1494

    Article  PubMed  Google Scholar 

  9. Zhang W, Doherty M, Peat G, Bierma-Zeinstra MA, Arden NK, Bresnihan B et al (2010) EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis 69(3):483–489

    Article  CAS  PubMed  Google Scholar 

  10. Newman S, Ahmed H, Rehmatullah N (2022) Radiographic vs. MRI vs. arthroscopic assessment and grading of knee osteoarthritis-are we using appropriate imaging? J Exp Orthop 9:1–6

    Article  Google Scholar 

  11. Scott CH, MacDonald DJ, Howie CR (2019) ‘Worse than death’ and waiting for a joint arthroplasty. Bone Joint J 101(8):941–950

    Article  PubMed  Google Scholar 

  12. Canada’s seniors population outlook (2017) Unchartered territory Ottawa, ON: Canadian Institute for Health Information; [Available from: https://www.cihi.ca/en/infographic-canadas-seniors-population-outlook-uncharted-territory.

  13. Badley EM, Wang PP (1998) Arthritis and the aging population: projections of arthritis prevalence in Canada 1991 to 2031. J Rheumatol 25(1):138–144

    CAS  PubMed  Google Scholar 

  14. Wennberg EAB, Takata JL, Urbach DR (2020) Elective surgery wait time reduction in Canada: a synthesis of provincial initiatives. Healthc Manage Forum 33(3):111–119

    Article  PubMed  Google Scholar 

  15. Stanley AL, Edwards TC, Jaere MD, Lex JR, Jones GG (2023) An automated, web-based triage tool may optimise referral pathways in elective orthopaedic surgery: a proof-of-concept study. Digit Health 9:20552076231152176

    PubMed  PubMed Central  Google Scholar 

  16. Agabiti N, Picciotto S, Cesaroni G, Bisanti L, Forastiere F, Onorati R et al (2007) The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study. Int J Qual Health Care 19(1):37–44

    Article  PubMed  Google Scholar 

  17. Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ et al (2008) Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg 51(6):428–436

    PubMed  PubMed Central  Google Scholar 

  18. Kralj B (2005) Measuring, “rurality” for purposes of health care planning: an empirical measure for Ontario. Ontario Medical Association, Toronto

    Google Scholar 

  19. Health Quality Ontario & Ministry of Health and Long-Term Care (2013) Quality-based procedures clinical handbook for primary hip and knee replacement available from: http://www.hqontario.ca/portals/0/documents/evidence/clinical-handbooks/hip-knee-140227-en.pdf

  20. Welk B, Loh E, Shariff SZ, Liu K, Siddiqi F (2014) An administrative data algorithm to identify traumatic spinal cord injured patients: a validation study. Spinal Cord 52(1):34–38

    Article  CAS  PubMed  Google Scholar 

  21. Widdifield J, Bombardier C, Bernatsky S, Paterson JM, Green D, Young J et al (2014) An administrative data validation study of the accuracy of algorithms for identifying rheumatoid arthritis: the influence of the reference standard on algorithm performance. BMC Musculoskelet Disord 15:216

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tu K, Campbell NR, Chen ZL, Cauch-Dudek KJ, McAlister FA (2007) Accuracy of administrative databases in identifying patients with hypertension. Open Med 1(1):e18-26

    PubMed  PubMed Central  Google Scholar 

  23. Canadian Institute for Health Information (2021) Wait times for priority procedures in Canada — data tables. Ottawa, ON: CIHI

  24. MRI and CT scan wait times (2021) Ontario, Canada: health quality Ontario

  25. Barua B, Moir M (2019) Waiting your turn: wait times for healthcare in Canada. Fraser Institute

  26. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. JClinEpidemiol 45(6):613

    CAS  Google Scholar 

  27. Voskuijl T, Hageman M, Ring D (2014) Higher Charlson comorbidity index scores are associated with readmission after orthopaedic surgery. Clin Orthop Relat Res 472(5):1638–1644

    Article  PubMed  Google Scholar 

  28. McConaghy KM, Orr MN, Emara AK, Sinclair ST, Klika AK, Piuzzi NS (2021) Can extant comorbidity indices identify patients who experience poor outcomes following total joint arthroplasty? Arch Orthop Trauma Surg 143(3):1253–1263. https://doi.org/10.1007/s00402-021-04250-y

    Article  PubMed  Google Scholar 

  29. Mannion AF, Nauer S, Arsoy D, Impellizzeri FM, Leunig M (2020) The association between comorbidity and the risks and early benefits of total hip arthroplasty for hip osteoarthritis. J Arthroplasty 35(9):2480–2487

    Article  PubMed  Google Scholar 

  30. Weiner JP, Abrams C (2011) The Johns Hopkins ACG® System: Technical Reference Guide Version 10.0

  31. Information CIfH (2008) Reducing gaps in health: a focus on socio-economic status in Urban Canada (Ottawa, Ont.: CIHI, 2008)

  32. Glazier R, Badley E, Gilbert J, Rothman L (2000) The nature of increased hospital use in poor neighbourhoods: findings from a Canadian inner city. Can J Public Health 91(4):268–273

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. OHIP bulletins Ontario: Ministry of Health (2021) [Available from: https://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/bulletin_interprovincial.aspx.

  34. Bergstein VE, Weinblatt AI, Taylor WL, Long WJ (2024) Total knee arthroplasty survivorship and outcomes in young patients: a review of the literature and 40-year update to a longitudinal study. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-024-05198-5

    Article  PubMed  Google Scholar 

  35. Osteoarthritis (2016) crude incidence rate, per 100,000, 2016 (fiscal year), Canada*. In: System CCDS, editor. Government of Canada

  36. Demeter S, Reed M, Lix L, MacWilliam L, Leslie WD (2005) Socioeconomic status and the utilization of diagnostic imaging in an urban setting. CMAJ 173(10):1173–1177

    Article  PubMed  PubMed Central  Google Scholar 

  37. Waite S, Scott J, Colombo D (2021) Narrowing the gap: imaging disparities in radiology. Radiology 299(1):27–35

    Article  PubMed  Google Scholar 

  38. Desmeules F, Dionne CE, Belzile E, Bourbonnais R, Fremont P (2010) The burden of wait for knee replacement surgery: effects on pain, function and health-related quality of life at the time of surgery. Rheumatology (Oxford) 49(5):945–954

    Article  PubMed  Google Scholar 

  39. Lizaur-Utrilla A, Martinez-Mendez D, Miralles-Munoz FA, Marco-Gomez L, Lopez-Prats FA (2016) Negative impact of waiting time for primary total knee arthroplasty on satisfaction and patient-reported outcome. Int Orthop 40(11):2303–2307

    Article  PubMed  Google Scholar 

  40. Canada: Canadian Institute for Health Information (2023) Joint replacement wait times. Available from: https://www.cihi.ca/en/indicators/joint-replacement-wait-times

  41. Osteoarthritis Tool. Canada (2017) Arthritis alliance Canada the center for effective practice college of family physicians of Canada

  42. Englund M, Guermazi A, Lohmander SL (2009) The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiol Clin North Am 47(4):703–712

    Article  PubMed  Google Scholar 

  43. Ijaz Khan H, Chou L, Aitken D, McBride A, Ding C, Blizzard L et al (2016) Correlation between changes in global knee structures assessed by magnetic resonance imaging and radiographic osteoarthritis changes over ten years in a midlife cohort. Arthritis Care Res (Hoboken) 68(7):958–964

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from ©Canada Post Corporation and Statistics Canada.

Funding

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC).

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada

    Tiffany Lung, Johnathan R. Lex, Daniel Pincus, David Wasserstein & Bheeshma Ravi

  2. Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada

    Daniel Pincus, David Wasserstein & Bheeshma Ravi

  3. ICES, Toronto, Canada

    Jodi Gatley & J. Michael Paterson

  4. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada

    Bheeshma Ravi

  5. Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 43 Wellesley St E, Room 315, Toronto, ON, M4Y 1H1, Canada

    Bheeshma Ravi

Authors
  1. Tiffany Lung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johnathan R. Lex
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Pincus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jodi Gatley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Wasserstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Michael Paterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bheeshma Ravi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bheeshma Ravi.

Ethics declarations

Conflict of interest

The authors have no potential conflicts of interest to disclose.

Ethical approval

Use of the data in this study was authorized under section 45 of Ontario’s Personal Health Information Protection Act, which does not require review by a Research Ethics Board. This is administrative data and therefore informed consent from each study subject is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lung, T., Lex, J.R., Pincus, D. et al. MRI use leading up to total knee arthroplasty: a retrospective cohort study. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03940-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00590-024-03940-8

Keywords

Search

Navigation