The Road to Total Knee Replacement - Utilisation of Knee Surgeries up to 10 Years Before TKR in England and Sweden.

Objectives To compare the prevalence and timing of knee surgery (including meniscal, ligamentous, synovial and osteotomy) in the ten years prior to primary total knee replacement (TKR) between England and Sweden. Methods This was a population-based, case-control study within England and southern Sweden using electronic healthcare databases. Cases underwent primary TKR between 2015 and 2019. Risk-set sampling identified general population controls matched 1:1 by age, sex and practice/municipality. The annual prevalence and prevalence ratio (PR) of having at least one recorded surgery in each of the 10 years preceding TKR was estimated using Poisson regressions. Results We included 6,308 and 47,010 TKR cases in Sweden and England, respectively. Meniscal surgeries were the most frequent procedure prior to TKR in both countries - prevalence was higher in England across all time points. The prevalence of meniscal surgery increased in both countries in the years approaching TKR, reaching 33.2 (95% confidence interval 31.6-34.9) per 1,000 persons in England, and 9.83 (7.66, 12.61) in Sweden. In England, we observed a decrease from 2014 to 2018 in the utilisation of this procedure in the four years preceding a TKR. The prevalence of all analysed surgeries was consistently lower in controls. Conclusions There are comparable trends in the use of knee surgery in the years preceding TKR across England and Sweden. Of note, meniscal surgeries remain common, even within the year prior to TKR, highlighting that these patients may experience low-value care. Careful consideration of knee surgery in those with late-stage disease is required.