Measures of the Appropriateness of Elective Orthopaedic Joint and Spine Procedures

Abstract

Total knee arthroplasty and total hip arthroplasty are 2 of the most commonly performed elective orthopaedic procedures. They are remarkably successful in relieving pain and improving function in individuals with advanced, symptomatic arthritis. Since, in addition to providing benefits, these procedures pose risks, it is important to provide clinicians with guidance in determining which patients should undergo total joint replacement surgery. The development of the RAND approach in 1986 and its application to total hip and knee replacement have enabled clinicians, payers, and others to assess the appropriateness of past and current procedures for particular patients. However, current appropriateness criteria for elective orthopaedic procedures have important limitations that suggest that they be used cautiously. New approaches to the assessment of appropriateness that overcome many of these limitations are under development.

In-situ generated tribomaterial in metal/metal contacts: Current understanding and future implications for implants

“…Total hip and knee replacements are widely regarded as successful surgical procedures with overall good clinical outcome [1]. This success, coupled with an aging population, has led to a steep increase in procedures during the last decade with currently more than 300,000 primary hips and twice as many knees performed each year in the United States alone [2].…”

Denosumab Prevents Early Periprosthetic Bone Loss After Uncemented Total Hip Arthroplasty: Results from a Randomized Placebo-Controlled Clinical Trial

“…Introduction P rimary total hip arthroplasty (THA) is one of the most common surgical procedures in the US, where the annual demand for THA is projected to exceed 500,000 by 2030. (1,2) With 10-year implant survival rates above 90% and enhanced quality of life, THA has proven to be an exceptionally successful intervention. (3,4) Yet, the growing number of primary THA procedures is associated with an increasing burden of revision THA surgery that is projected to increase dramatically, implying that 50,000 to 100,000 hip revision procedures will be performed in 2030 in the US alone.…”

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

“…Given the substantial growth in TKA utilization in the US, and the uncertainty in defining candidacy for this elective procedure, there is renewed interest in establishing well-defined criteria for determining when a patient is an appropriate candidate for the procedure 6,7 . The most commonly discussed appropriateness system for TKA was published in 2003 by Escobar and colleagues 8 .…”