Appropriateness and total knee arthroplasty: an examination of the American Academy of Orthopaedic Surgeons appropriateness rating system

Riddle, Daniel L.; Perera, Robert A.

doi:10.1016/j.joca.2017.08.018

Cited by 22 publications

(26 citation statements)

References 9 publications

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“…The system developed by Escobar and colleagues was based on an evidence synthesis that is ~2 decades old and, given dramatic growth in TKA technologies, evidence, and indications (11), an updated RAND/UCLA system is needed. The shortcomings of a recently developed RAND/UCLA–based system for TKA (12), and the continued high utilization of TKA (13) in the face of a 20% rate of persistent knee pain following surgery (14), amplify the need for an alternative.…”

Section: Introductionmentioning

confidence: 99%

Development and Underlying Structure of a Second‐Generation Appropriateness Classification System for Total Knee Arthroplasty

Soriano

Perera

Riddle

2021

Arthritis Care & Research

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Objective Evidence supports the validity of total knee arthroplasty (TKA) appropriateness classification based on the RAND Corporation and University of California Los Angeles system.The system, however, is ~2 decades old, and the science and clinical application of TKA has changed dramatically. We undertook this study to describe the methods used to develop a second‐generation system and to examine the structure of the system to determine the extent to which each of the indication criteria informed appropriateness. Methods Multivariable multinomial regression analyses determined the extent to which each of the 8 individually analyzed indication criteria informed appropriateness judgments. Classification tree analysis illustrates how the indication criteria, in combination, led to judgments of appropriate, inappropriate, or uncertain. Results An expert panel selected 8 indication criteria (i.e., age, knee pain, function, radiographic osteoarthritis severity, osteoarthritis location, psychological factors, pain catastrophizing, and comorbidities). A total of 1,008 clinical scenarios were written, based on the criteria. Regression analyses indicated that age, knee pain, function, and radiographic severity dominated prediction of appropriateness, while the other criteria played a smaller role. Classification tree analysis confirmed the regression findings. Conclusion Our second‐generation classification system, which incorporates contemporary indicators of TKA prognosis and risk, demonstrated preliminary evidence for utility in clinical practice.

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Section: Introductionmentioning

confidence: 99%

Development and Underlying Structure of a Second‐Generation Appropriateness Classification System for Total Knee Arthroplasty

Soriano

Perera

Riddle

2021

Arthritis Care & Research

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“… 2016 , Skou et al. 2016 , Riddle and Perera 2017 ). As patients receiving arthroplasty may not have been the only ones needing arthroplasty, these variations may have diluted our analysis, leading to either an under- or an overestimation of our effect sizes.…”

Section: Discussionmentioning

confidence: 98%

The course of pain and function in osteoarthritis and timing of arthroplasty: the CHECK cohort

et al. 2018

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Background and purpose — It is unknown whether different trajectories of pain or function are associated with timing of total hip or knee arthroplasty (THA/TKA) in osteoarthritis (OA) patients. We investigated this association in early symptomatic OA patients.Patients and methods — Data from the prospective Dutch CHECK cohort (patients with early hip/knee OA complaints) covering 9 years of follow-up were used. Pain and function were measured annually using the WOMAC questionnaires. Changes in pain/function over time were estimated using a linear mixed model adjusted for baseline age, sex, BMI, maximal Kellgren and Lawrence score, number of painful joints, and comorbidities. The same covariates were included in a Cox regression model, with time to first arthroplasty as event. Both were combined in a joint model to assess the association between changes in pain/function and time to arthroplasty.Results — Of the 868 eligible patients, 84 received a TKA/THA during follow-up. Patients receiving arthroplasty were somewhat older, had a higher Kellgren and Lawrence score and worse WOMAC scores at baseline. Irrespective of receiving arthroplasty, about two-thirds of the patients showed at least 1 period of deterioration of pain/function (≥ 10 points WOMAC subscale). In approximately two fifths this deterioration was followed by another deterioration in the following year. Worse pain and function levels increased the hazard of receiving THA/TKA (1.08 [95% CI 1.06–1.10] for pain and 1.07 [CI 1.05–1.08] for function). Changes in pain or function over time were not associated with timing of THA/TKAInterpretation — Worse pain and function levels rather than long-term changes are associated with timing of THA/TKA.

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“…In our view, this finding is likely attributable either to a relative lack of prognostic evidence for these variables or to an overreliance by the expert panel on more traditional variables. Either way, the expert panel placed minimal emphasis on function‐limiting pain when judging appropriateness, much like the AAOS knee arthroplasty appropriateness system . In our view, the literature lacks high‐quality studies examining the effects of function‐limiting pain and hip range of motion on outcomes.…”

Section: Discussionmentioning

confidence: 99%

American Academy of Orthopedic Surgeons Appropriate Use Criteria for Hip Preservation Surgery: Variables That Drive Appropriateness for Surgery

Riddle

Perera

2020

Arthritis Care & Research

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Objective Determining appropriate candidates for hip preservation surgery is challenging because criteria for judging appropriateness are not defined. The American Academy of Orthopaedic Surgeons (AAOS) recently published a hip preservation surgery appropriateness classification system using the RAND/University of California, Los Angeles approach. This study was undertaken to determin the extent and pattern of contribution of each of the variables used to predict the appropriateness of hip preservation surgery. Methods An AAOS‐appointed multidisciplinary expert panel wrote 270 clinical vignettes incorporating all permutations of 5 indication variables derived from an evidence synthesis. A second independent panel of experts rated the appropriateness of each vignette during multiple Delphi surveys. We used logistic regression to determine the relative contribution of each variable to classification. We also used a classification‐tree approach to determine which indication variables, in combination, contributed to the final classification. Results Odds ratios from the regression indicated that patient age and radiographic hip osteoarthritis (OA) evaluation were the main indications of appropriateness classification (e.g., the odds ratio for age <40 years was >999.99, with age >65 years as the referent group, for “appropriate/may be appropriate” as compared to “rarely appropriate” vignettes). Hip range of motion, risk for negative outcome, and function‐limiting pain did not meaningfully contribute to the final classification. Conclusion The AAOS appropriateness classification system for hip preservation surgery is driven almost exclusively by age and radiographic hip OA evaluation. Additional research on appropriateness classification for hip preservation surgery is needed to identify important indication variables beyond age and radiographic hip findings.

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Appropriateness and total knee arthroplasty: an examination of the American Academy of Orthopaedic Surgeons appropriateness rating system

Cited by 22 publications

References 9 publications

Development and Underlying Structure of a Second‐Generation Appropriateness Classification System for Total Knee Arthroplasty

Development and Underlying Structure of a Second‐Generation Appropriateness Classification System for Total Knee Arthroplasty

The course of pain and function in osteoarthritis and timing of arthroplasty: the CHECK cohort

American Academy of Orthopedic Surgeons Appropriate Use Criteria for Hip Preservation Surgery: Variables That Drive Appropriateness for Surgery

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