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Multicenter Study
. 2014 Aug;66(8):2134-43.
doi: 10.1002/art.38685.

Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study

Daniel L Riddle  1 , William A Jiranek, Curtis W Hayes
Affiliations
Multicenter Study

Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study

Daniel L Riddle et al. Arthritis Rheumatol. 2014 Aug.

Abstract

Objective: In previous studies conducted outside the US, ∼20% of total knee arthroplasty (TKA) surgeries were judged to be inappropriate. The present study was undertaken to determine the prevalence rates of TKA surgeries classified as appropriate, inconclusive, and inappropriate in a knee osteoarthritis population in the US.

Methods: We used a modification of a validated appropriateness classification system and applied it to patients in the Osteoarthritis Initiative data set who underwent TKA. A variety of preoperative data were used in the classification, including Western Ontario and McMaster Universities Osteoarthritis Index pain and physical function scores, radiographic features, knee motion and laxity measures, and age.

Results: Data on 205 patients who underwent TKA were examined. The prevalence rates for classification of the procedure as appropriate, inconclusive, and inappropriate were 44.0% (95% confidence interval [95% CI] 37-51%), 21.7% (95% CI 16-28%), and 34.3% (95% CI 27-41%), respectively.

Conclusion: Approximately one-third of TKA surgeries were judged to be inappropriate. Variation in the characteristics of patients undergoing TKA was extensive. These data support the need for consensus development of criteria for patient selection among US practitioners treating patients who are potential candidates for TKA. Among the important issues, consensus development needs to address variation in patient characteristics and the relative importance of preoperative status and subsequent outcome.

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Conflict of interest statement

Competing Interest Statement: The authors had no competing interests that that could potentially and inappropriately influence (bias) their work and conclusions.

Figures

Figure 1
Figure 1
The flow of patients through the study.
Figure 2
Figure 2
The figure illustrates the left side of the algorithm modified from that developed by Escobar and colleagues for classifying total knee arthroplasty procedures as appropriate, inappropriate or inconclusive. The terminal nodes of each branch of the algorithm are labeled with the number of subjects who matched the criteria for each branch. The small number in the upper right hand corner of each terminal node indicates whether the terminal node is classified as inconclusive (# 16) or inappropriate (#s 12, 13, 14 and 15)
Figure 3
Figure 3
The figure illustrates the right side of the algorithm modified from that proposed by Escobar and colleagues for classifying total knee arthroplasty procedures as appropriate, inappropriate or inconclusive. The terminal nodes of each branch of the algorithm are labeled with the number of subjects who matched the criteria for each branch. The small number in the upper right hand corner of each terminal node indicates whether the terminal node is classified as appropriate (#s 1, 2, 4, and 6), inconclusive (#s 3, 5, 7, 9 and 11) or inappropriate (#s 8 and 10)
See this image and copyright information in PMC

Comment in

References

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