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. 2023 May;75(5):1132-1139.
doi: 10.1002/acr.24961. Epub 2022 Dec 23.

Incorporating Expected Outcomes Into Clinical Decision-Making for Total Knee Arthroplasty

Hassan M K Ghomrawi  1 , Daniel L Riddle  2 , Mohamed M Hasan  1 , Jing Song  1 , Raymond H Kang  1 , Lisa A Mandl  3 , Michael L Parks  4 , Mohamed Moussa  5 , Matthew Beal  6 , Linda A Russell  4 , Jason S Mathias  1 , Pamela Semanik  7 , Dorothy D Dunlop  1 , Patricia D Franklin  1 , Rowland W Chang  1
Affiliations

Incorporating Expected Outcomes Into Clinical Decision-Making for Total Knee Arthroplasty

Hassan M K Ghomrawi et al. Arthritis Care Res (Hoboken). 2023 May.

Abstract

Objective: Expected outcomes (e.g., expected survivorship after a cancer treatment) have improved decision-making around treatment options in many clinical fields. Our objective was to evaluate the effect of expected values of 3 widely available total knee arthroplasty (TKA) outcomes (risk of serious complications, time to revision, and improvement in pain and function at 2 years after surgery) on clinical recommendation of TKA.

Methods: The RAND/University of California Los Angeles appropriateness criteria method was used to evaluate the role of the 3 expected outcomes in clinical recommendation of TKA. The expected outcomes were added to 5 established preoperative factors from the modified Escobar appropriateness criteria. The 8 indication factors were used to develop 279 clinical scenarios, and a panel of 9 clinicians rated the appropriateness of TKA for each scenario as inappropriate, inconclusive, and appropriate. Classification tree analysis was applied to these ratings to identify the most influential of the 8 factors in discriminating TKA appropriateness classifications.

Results: Ratings for the 279 appropriateness scenarios deemed 34.4% of the scenarios as appropriate, 40.1% as inconclusive, and 25.5% as inappropriate. Classification tree analyses showed that expected improvement in pain and function and expected time to revision were the most influential factors that discriminated among the TKA appropriateness classification categories.

Conclusion: Our results showed that clinicians would use expected postoperative outcome factors in determining appropriateness for TKA. These results call for further work in this area to incorporate estimates of expected pain/function and revision outcomes into clinical practice to improve decision-making for TKA.

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Figures

Figure 1.
Figure 1.
CART analysis showing the most influential factors in determining appropriateness ratings. Classification accuracy was 74.6%.
See this image and copyright information in PMC

References

    1. Mahomed NN, Barrett J, Katz JN, Baron JA, Wright J, Losina E. Epidemiology of total knee replacement in the United States Medicare population. J Bone Joint Surg Am. 2005;87(6):1222–8. - PubMed
    1. Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991–2010. JAMA. 2012;308(12):1227–36. - PMC - PubMed
    1. Racial disparities in total knee replacement among Medicare enrollees--United States, 2000–2006. MMWR Morbidity and mortality weekly report. 2009;58(6):133–8. - PubMed
    1. Singh JA, Vessely MB, Harmsen WS, Schleck CD, Melton LJ 3rd, Kurland RL, et al. A population-based study of trends in the use of total hip and total knee arthroplasty, 1969–2008. Mayo Clin Proc. 2010;85(10):898–904. - PMC - PubMed
    1. Ghomrawi HM, Schackman BR, Mushlin AI. Appropriateness criteria and elective procedures--total joint arthroplasty. N Engl J Med. 2012;367(26):2467–9. - PubMed

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