OARSI/OMERACT Initiative to Define States of Severity and Indication for Joint Replacement in Hip and Knee Osteoarthritis. An OMERACT 10 Special Interest Group

Abstract

Objective To define pain and physical function cutpoints that would, coupled with structural severity, define a surrogate measure of “need for joint replacement surgery,” for use as an outcome measure for potential structure-modifying interventions for osteoarthritis (OA). Methods New scores were developed for pain and physical function in knee and hip OA. A cross-sectional international study in 1909 patients was conducted to define data-driven cutpoints corresponding to the orthopedic surgeons’ indication for joint replacement. A post hoc analysis of 8 randomized clinical trials (1379 patients) evaluated the prevalence and validity of cutpoints, among patients with symptomatic hip/knee OA. Results In the international cross-sectional study, there was substantial overlap in symptom levels between patients with and patients without indication for joint replacement; indeed, it was not possible to determine cutpoints for pain and function defining this indication. The post hoc analysis of trial data showed that the prevalence of cases that combined radiological progression, high level of pain, and high degree of function impairment was low (2%–12%). The most discriminatory cutpoint to define an indication for joint replacement was found to be [pain (0–100) + physical function (0–100) > 80]. Conclusion These results do not support a specific level of pain or function that defines an indication for joint replacement. However, a tentative cutpoint for pain and physical function levels is proposed for further evaluation. Potentially, this symptom level, coupled with radiographic progression, could be used to define “nonresponders” to disease-modifying drugs in OA clinical trials.

Osteoarthritis as a Cause of Locomotive Syndrome: Its Influence on Functional Mobility and Activities of Daily Living

“…However, there are no current symptoms which clearly indicate a need to perform joint replacement surgery [5,17]. Setting objective indications for joint replacement surgery in patients with knee OA has long been a goal of researchers [18][19][20][21][22][23][24]. However, the decision whether to undergo joint replacement for patients with agerelated chronic diseases, such as OA, is often difficult, with no clear-cut indications for the procedure [25,26].…”

Updating the OMERACT Filter: Implications for Imaging and Soluble Biomarkers

“…The ability to identify patients who may subsequently benefit from joint replacement is difficult to determine because of several contributory factors including that the decision to undertake surgery, despite clinical symptoms, is determined by multiple issues such as healthcare access, individual surgeon, and patient factors (including comorbidities). An OMERACT/Osteoarthritis Research Society International working group has proposed criteria for a "virtual" joint replacement outcome given these factors 67,68 . Previous OMERACT recommendations have included plain radiographs as an outcome measure in a core set for structural modification in OA 69,70 .…”

A study protocol for the profile of pain in older women: assessing the multi dimensional nature of the experience of pain in arthritis

“…The survey will use measures of health, arthritis and pain as recommended by international bodies OARSI and Outcome Measures in Rheumatology (OMERACT) [15,18,[33][34][35][36][37][38][39][40][41], and reports from expert panels [12]. The measures and their appropriateness for inclusion are discussed below (see Table 1).…”