These results suggest a direct relationship between explicit appropriateness criteria and better health-related quality-of-life outcomes after THR and TKR surgery. Our results support the use of these criteria for clinical guidelines or evaluation purposes.

No abstract

The study identified a moderate percentage of inappropriately performed THR. When considered together with those cases that were judged to have uncertain indications, the results indicate that further studies should be done to identify patients who may have an inadequate benefit:risk ratio from this procedure.

We identified a low percentage of inappropriate indications and differences in some outcomes between centres. Compared with previously, there has been improvement in the use of this technique, although both periods are not methodologically comparable.

A simple decision tree based on WOMAC outcomes can help to determine the appropriate application of THR. It could also be used to evaluate clinical practice or for quality control.