The utility of MRI scans for a painful knee in the elderly patient

Abstract

Introduction

We assess the requesting patterns and overall utility of MRI scans in our institution over a 6-month period for knee pain in an elderly population.

Methods

We performed a retrospective cohort study analysing patients undergoing a knee MRI between June 2018 and January 2019. Clinical notes were reviewed to determine the nature of any surgical intervention that was performed as a result of the MRI findings. A simple economic analysis was then performed using local pricing information.

Results

One hundred and nine MRI scans were performed. The majority of scans were ordered by primary care physicians with no preceding plain radiographs (55%, n = 60). Meniscal tears were reported in 68% of patients. Degenerative changes were noted in 82% of patients. One patient was noted to have a flipped meniscal fragment. This was the only patient to undergo surgical intervention of any kind. Univariate analysis demonstrated no correlation between the presence of a meniscal tear (p = 0.61) or degeneration (p = 0.56) and the need for intervention. The only significant predictor of intervention was the presence of locking (p < 0.001). For the 101 patients that underwent unnecessary MRI scans, our institution would have saved €17,170 in unnecessary costs over 6 months.

Conclusion

We suggest that all elderly patients with knee pain undergo plain radiographs before MRI scan and only those with locking should be considered for an MRI scan at all. Primary care physicians are overusing MRI as an imaging modality in this cohort at a cost of over €30,000 per year to our institution.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Ackerman IN, Bohensky MA, Zomer E, Tacey M, Gorelik A, Brand CA et al (2019) The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord 20(1):90

    Article  Google Scholar 

  2. 2.

    Kurtz SM, Ong KL, Lau E, Bozic KJ (2014) Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am 96(8):624–630

    Article  Google Scholar 

  3. 3.

    (2019) Payers price list. In: (ed). Hospital OLoL

  4. 4.

    Wylie JD, Crim JR, Working ZM, Schmidt RL, Burks RT (2015) Physician provider type influences utilization and diagnostic utility of magnetic resonance imaging of the knee. J Bone Joint Surg Am 97(1):56–62

    Article  Google Scholar 

  5. 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. 6.

    Petron DJ, Greis PE, Aoki SK, Black S, Krete D, Sohagia KB et al (2010) Use of knee magnetic resonance imaging by primary care physicians in patients aged 40 years and older. Sports Health 2(5):385–390

    Article  Google Scholar 

  7. 7.

    Solivetti FM, Guerrisi A, Salducca N, Desiderio F, Graceffa D, Capodieci G et al (2016) Appropriateness of knee MRI prescriptions: clinical, economic and technical issues. Radiol Med 121(4):315–322

    CAS  Article  Google Scholar 

  8. 8.

    NICE. Arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis 2007. Available from: https://www.nice.org.uk/guidance/ipg230

  9. 9.

    Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C (2008) Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev 1:CD005118

    Google Scholar 

  10. 10.

    Lazic S, Boughton O, Hing C, Bernard J (2014) Arthroscopic washout of the knee: a procedure in decline. Knee. 21(2):631–634

    Article  Google Scholar 

  11. 11.

    Amin N, McIntyre L, Carter T, Xerogeanes J, Voigt J (2019) Cost-effectiveness analysis of needle arthroscopy versus magnetic resonance imaging in the diagnosis and treatment of meniscal tears of the knee. Arthroscopy. 35(2):554–62 e13

    Article  Google Scholar 

Download references

Availability of data and material

Available on request.

Code availability

Not applicable.

Author information

Affiliations

Authors

Contributions

AB, data collection and manuscript writing; GS, manuscript writing and statistics; AG, study design and manuscript editing.

Corresponding author

Correspondence to Gerard A. Sheridan.

Ethics declarations

Conflicts of interest

Not applicable.

Ethics approval

Granted by the Local Institutional Review Board.

Consent to participate

Granted.

Consent for publication

Granted.

Additional information

Publisher’s note

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

‘Deerpark’, Lobinstown, Navan, Co.Meath

Abishekar Bisseru, Aaron A Glynn are Co-authors

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sheridan, G.A., Bisseru, A. & Glynn, A.A. The utility of MRI scans for a painful knee in the elderly patient. Ir J Med Sci 190, 363–366 (2021). https://doi.org/10.1007/s11845-020-02261-z

Download citation

Keywords

  • Cost-effectiveness
  • Knee
  • MRI
  • Osteoarthritis