Using a Validated Algorithm to Judge the Appropriateness of Total Knee Arthroplasty in the United States: A Multi-Center Longitudinal Cohort Study
Daniel L. Riddle, PT, PhD, FAPTA,1,2 William A. Jiranek, MD,2 and Curtis W. Hayes, MD3Knee
Objective
We used a modified version of validated appropriateness criteria to determine the prevalence rates of total knee arthroplasty (TKA) surgeries that were classified as appropriate, inconclusive or inappropriate. Based on prior evidence, we hypothesized that the prevalence of TKA surgeries classified as inappropriate would approximate 20%.
Methods
The appropriateness classification system was adapted for use on persons undergoing TKA in the Osteoarthritis Initiative dataset. A variety of pre-operative data were used including WOMAC Pain and Physical Function scores, radiographic and knee motion and laxity measures and age. Prevalence rates for classifications of appropriate, inconclusive and inappropriate were calculated.
Results
Data from 205 persons with TKA were examined. The prevalence rate was 44.0% (95%CI= 37, 51) for classifications of appropriate, 21.7% (95%CI = 16, 28) for inconclusive classifications and 34.3% (95%CI =27, 41) for inappropriate classifications.
Conclusion
Approximately a third of TKA surgeries were judged to be inappropriate. Variation in the characteristics of persons undergoing TKA was extensive. These data support the need for consensus development of criteria for patient selection among practitioners in the US treating potential TKA candidates. Among the important issues, consensus development needs to address variation in patient characteristics and the relative importance of pre-operative status and subsequent outcome.
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