OBJECTIVE: The aim of this study was to evaluate the potential adverse effects of prior arthroscopic knee surgery on the prognosis of primary total knee arthroplasty (TKA). METHODS: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed in the PubMed, Embase, Cochrane Library, and other relevant databases up to October 2024. Cohort studies comparing the outcomes of patients with and without previous arthroscopic knee surgery were retrieved. Meta-analysis was performed to assess the differences in postoperative function, complications, and revision rates between the arthroscopy and primary TKA groups. RESULTS: The analysis included 11 cohort studies comprising a total of 194,367 patients
13,086 of these patients had a history of knee arthroscopy. The meta-analysis results revealed no significant differences in postoperative range of motion, functional improvement, stiffness, periprosthetic fracture, venous thromboembolism (VTE), and other complications between the groups. However, the arthroscopic group showed a higher risk of postoperative prosthetic joint infection (PJI) and manipulation under anaesthesia (MUA). The revision rate was also higher in the arthroscopic group (Relative Risk (RR) 1.423, 95% Confidence Interval (CI) 1.280 to 1.583). Subgroup analysis revealed an increased PJI risk within one year of arthroscopic TKA (RR 1.314, 95% CI 1.156 to 1.493). Sensitivity analysis confirmed the stability of the results, and Egger's test showed no publication bias. CONCLUSION: Prior arthroscopic surgery was not found to have significant impacts on the functional outcomes of TKA but was found to increase the risks of postoperative infection and revision.