Criteria used when deciding on eligibility for total knee arthroplasty — Between thinking and doing

Abstract

Radiographic severity and functional limitations were confirmed as drivers for TKA eligibility, while pain was not. Not responding to non-surgical treatment was not included in the decision-making, suggesting low uptake of clinical guidelines in clinical practice. This study highlights the complexity of the decision-making with some overlap between the criteria that OSs think they apply and what is actually applied in clinical practice.

Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials

“…Our finding of similar baseline pain levels between the two RCTs 16 confirms previous findings of a large overlap in preoperative symptoms among patients found eligible or not eligible for TKR 37,38 . On the other hand, we found that patients eligible for TKR had worse function and more severe radiographic OA 16 .…”

“…The major differences between patients in the two RCTs were their radiographic OA severity, level of functional limitation and whether they were eligible for TKR or not, while they were of similar age and had similar baseline pain intensity 16 .…”

“…The two trials were similarly designed, used the same individualized supervised non-surgical treatments and outcomes, and were conducted in parallel with patients recruited by the same surgeons and sites 14,15 . Across trials, patients were of similar age and reported similar baseline pain levels 16 . The major differences were the patients' eligibility for TKR 14,15 and their radiographic OA severity 16 .…”

“…Across trials, patients were of similar age and reported similar baseline pain levels 16 . The major differences were the patients' eligibility for TKR 14,15 and their radiographic OA severity 16 .…”

Muscle strength, physical performance and physical activity as predictors of future knee replacement: a prospective cohort study

“…When the results were adjusted for radiographic OA severity, the associations were non-significant, highlighting radiographic severity as an important driver of KR as previously demonstrated 26, 27 . As lower knee extensor strength is a known risk factor for OA incidence 28 and progression 5, 6 , adjusting for radiographic severity, an intermediary in the path between lower muscle strength and KR, attenuates the relationship with knee extensor strength.…”