Validation of a second-generation appropriateness classification system for total knee arthroplasty: a prospective cohort study

Escobar, Antonio; Bilbao‐González, Amaia; Bertrand, Maria; Moreta, Jesús; Froufe, Miquel A.; Colomina, Jordi; Martínez-Cruz, Olga; Perera, Robert A.; Riddle, Daniel L.

doi:10.1186/s13018-021-02371-z

Cited by 10 publications

(10 citation statements)

References 27 publications

(39 reference statements)

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“…There is strong consensus that TKA should be offered to individuals with knee symptoms that are negatively affecting quality of life despite a trial of non-surgical therapies. 15 16 25–27 However, only 71% of our TKA recipients had received recommended OA therapies. Although we did not find that receipt of prior recommended OA therapies was associated with TKA outcome, it is reasonable to expect that non-surgical therapies have been exhausted before a costly and potentially risky procedure is performed.…”

Section: Discussionmentioning

confidence: 96%

“… 15 16 18 Using the Spanish criteria, Escobar et al found that appropriate candidates were more likely than those deemed inappropriate to experience minimally important improvements in pain and function at follow-up, but outcomes were similar for those deemed appropriate versus uncertain and level of satisfaction was similar across groups. 15 Furthermore, both the Spanish and AAOS criteria ask surgeons to make assumptions regarding the patients whose TKA appropriateness they are assessing. In development of the Spanish criteria, experts were instructed to assume that the patient had unilateral knee symptoms, a BMI<40 kg/m 2 , adequate social support and received appropriate knee OA management and their expectations had been addressed appropriately.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, TKA appropriateness criteria should be used to determine if it is reasonable to consider operating given a patient’s particular circumstances 12 13. Yet, to date, there has been little or no involvement of patients with knee OA in the development or validation of TKA appropriateness criteria or decision-support tools 14–18. Most have been developed based on expert clinician consensus informed by the best available scientific evidence 9 15 16 18–20.…”

Section: Introductionmentioning

confidence: 99%

“…Yet, to date, there has been little or no involvement of patients with knee OA in the development or validation of TKA appropriateness criteria or decision-support tools 14–18. Most have been developed based on expert clinician consensus informed by the best available scientific evidence 9 15 16 18–20. Existing tools generally consider patients’ symptoms, comorbidity, radiographic severity and clinical examination (knee mobility and stability) 17 21.…”

Section: Introductionmentioning

confidence: 99%

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Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome

et al. 2023

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ObjectivesOne-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients’ preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of TKA need, readiness/willingness and expectations for a good TKA outcome.MethodsIn patients with knee osteoarthritis (OA) undergoing primary TKA, we preoperatively assessed TKA need (Western Ontario-McMaster Universities OA Index (WOMAC) Pain Score and Knee injury and Osteoarthritis Outcome Score (KOOS) function, arthritis coping), health status, readiness (Patient Acceptable Symptom State, depressive symptoms), willingness (definitely yes—yes/no) and expectations (outcomes deemed ‘very important’). A good outcome was defined as symptom improvement (met Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT–OARSI) responder criteria) and satisfaction with results 1 year post TKA. Using logistic regression, we assessed independent outcome predictors, model discrimination (area under the receiver operating characteristic curve, AUC) and the predicted probability of a good outcome for different need, readiness/willingness and expectations scenarios.ResultsOf 1,053 TKA recipients (mean age 66.9 years (SD 8.8); 58.6% women), 78.1% achieved a good outcome. With TKA need alone (WOMAC pain subscale, KOOS physical function short-form), model discrimination was good (AUC 0.67, 95% CI 0.63 to 0.71). Inclusion of readiness/willingness, depressive symptoms and expectations regarding kneeling, stair climbing, well-being and performing recreational activities improved discrimination (p=0.01; optimism corrected AUC 0.70, 0.66–0.74). The predicted probability of a good outcome ranged from 44.4% (33.9–55.5) to 92.4% (88.4–95.1) depending on level of TKA need, readiness/willingness, depressive symptoms and surgical expectations.ConclusionsAlthough external validation is required, our findings suggest that incorporation of patients’ TKA readiness, willingness and expectations in TKA decision-making may improve the proportion of recipients that experience a good outcome.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome

et al. 2023

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“…Short-term outcomes were as follows: operation time, length of hospital stay, and straight leg raising time. Long-term clinical effect mainly including Insall-Salvati ratio; range of motion at 1 month, 3 months, and 1 year following TKR; and visual analog scale (VAS) at 1 month, 3 months, and Knee Society Score (KSS) score [ 12 , 13 ] at 1 year following TKR. The ISR Insall-Salvati ratio is the ratio between the length of the patellar tendon and length of the patella.…”

Section: Methods and Analysismentioning

confidence: 99%

Patellar retraction versus eversion on functional outcomes in total knee replacement: a randomized controlled study protocol

Wang

Bao

et al. 2021

J Orthop Surg Res

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Background Patellar mobilization technique during total knee replacement (TKR) has been debated, with some suggesting that lateral retraction, rather than eversion, of the patella may be beneficial. This randomized controlled trial was to investigate the effects of patellar eversion on functional outcomes in TKR. Methods and analysis This single-center, prospective, randomized controlled test will be conducted in Jingjiang People's Hospital. Primary end-stage osteoarthritis patients that prepared for unilateral TKR were randomized to one of two patellar exposure techniques during the primary total knee arthroplasty: lateral retraction or eversion. The informed consent will be acquired in each patient. The primary outcome was operation time, length of hospital stay, and straight leg raising time. Second outcomes including Insall-Salvati ratio; range of motion at 1 month, 3 months, and 1 year following TKR; visual analog scale (VAS) at 1 month, 3 months; and Knee Society Score (KSS) score at 1 year following TKR. The significance level was defaulted as P < .05. Results Results will be published in relevant peer-reviewed journals. Conclusion Our study aims to systematically assess the functional outcomes of patellar eversion for TKR patients, which will provide clinical guidance for TKR patients.

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The Devil Is in the Detail: Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty

Hawker

2023

Arthritis Care & Research

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What is the optimal timing for hip or knee total joint arthroplasty (TJA) in people with symptomatic and moderate-to-severe radiographic osteoarthritis (OA) or osteonecrosis (ON) who have not responded to nonoperative treatments? The new clinical practice guidelines by the American College of Rheumatology (ACR) and American Academy of Hip and Knee Surgeons (AAHKS) (1), published in this issue of Arthritis Care & Research, sought to provide evidence-based recommendations to address this question. This is an important topic. With rising prevalence of symptomatic knee OA, including at younger ages, the rates and associated costs of TJA are skyrocketing (2). Policies that restrict access to TJA have emerged to combat rising TJA costs, ideally while also ensuring access and quality of care. The new recommendations aim to inform shared decision-making (SDM) between patients and clinicians regarding TJA while also challenging health insurance coverage policies that restrict timely access to TJA. The conditional recommendations are based on low or very low-quality evidence. Thus, they provide little substance to guide TJA shared decision-making, other than underscoring the importance of SDM in the context of TJA. However, they do serve to highlight the tremendous burden on patients imposed by advanced, symptomatic hip and knee arthritis and the injustice of imposing undue delays to receipt of TJA to candidates deemed "appropriate" for surgery.In essence, the guideline recommends that people who are deemed "appropriate" for TJA at surgical consultation should not have their surgery delayed for additional trials of nonoperative treatments, e.g., physical therapy, nonsteroidal antiinflammatory drugs, ambulatory aids, and intraarticular injections. At face value, this seems reasonable. But, as is often the case, the devil is in the details. Whether or not these recommendations will shift coverage policy makers' stance is unclear for the following reasons:First, the authors are careful to state, and restate, that their recommendations do not apply to patients who are not

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Validation of a second-generation appropriateness classification system for total knee arthroplasty: a prospective cohort study

Cited by 10 publications

References 27 publications

Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome

Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome

Patellar retraction versus eversion on functional outcomes in total knee replacement: a randomized controlled study protocol

The Devil Is in the Detail: Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty

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