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

Author:

Escobar Antonio,Bilbao AmaiaORCID,Bertrand Maria L.,Moreta Jesús,Froufe Miquel A.,Colomina Jordi,Martınez-Cruz Olga,Perera Robert A.,Riddle Daniel L.

Abstract

Abstract Background To test the validity of a second-generation appropriateness system in a cohort of patients undergoing total knee arthroplasty (TKA). Methods We applied the RAND/UCLA Appropriateness Method to derive our second-generation system and conducted a prospective study of patients diagnosed with knee osteoarthritis in eight public hospitals in Spain. Main outcome questionnaires were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form-12 (SF-12), and the Knee Society Score satisfaction scale (KSS), completed before and 6 months after TKA. Baseline, changes from baseline to 6 months (journey outcome), and 6-month scores (destination outcome) were compared according to appropriateness category. Percentage of patients attaining the minimal clinically important difference (MCID) and responders according to Outcome Measures in Rheumatology-Osteoarthritis Research Society (OMERACT-OARSI) criteria were also reported. Results A total of 282 patients completed baseline and 6-month questionnaires. Of these, 142 (50.4%) were classified as Appropriate, 90 (31.9%) as Uncertain, and 50 (17.7%) as Inappropriate. Patients classified as Appropriate had worse preoperative pain, function, and satisfaction (p < 0.001) and had greater improvements (i.e., journey scores) than those classified as Inappropriate (p < 0.001). At 6 months, destination scores for pain, function, or satisfaction were not significantly different across appropriateness categories. The percentage of patients meeting responder criteria (p < 0.001) and attaining MCID was statistically higher in Appropriate versus Inappropriate groups in pain (p = 0.04) and function (p = 0.004). Conclusions The validity of our second-generation appropriateness system was generally supported. The findings highlight a critical issue in TKA healthcare: whether TKA appropriateness should be driven by the extent of improvement, by patient final state, or by both.

Funder

Instituto de Salud Carlos III

Departamento de Salud del Gobierno Vasco

European Regional Development Fund

Publisher

Springer Science and Business Media LLC

Subject

Orthopedics and Sports Medicine,Surgery

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