Eligibility criteria for a total knee arthroplasty (TKA)
The number of total knee arthroplasty (TKA) operations is still rising. However, the TKA eligibility criteria still remain heterogenous. Thus, this study aimed to compare the TKA eligibility criteria considered most important by orthopedic surgeons. It was shown that radiographic severity as well as functional limitations were the main drivers. Surprisingly, pain and the response to non-surgical treatment were not.
TKA has been shown to be an effective treatment of end-stage knee osteoarthritis (OA). However, a systematic review revealed that 20% of patients who underwent a TKA showed only small or no improvements in pain. One way to improve patient satisfaction might be to refine the eligibility criteria for a TKA, to enable an appropriate selection of patients that are likely to benefit from the operation.
Therefore, this study investigated the data of 200 patients with knee OA, which had enrolled in an RCT. The eligibility for TKA (yes/ no) was assessed by orthopedic surgeons (OSs) and divided the study population into two equally sized groups (100 patients eligible for a TKA, and 100 patients not eligible). This data allowed determination of the predictor criteria for the TKA eligibility.
The data showed that radiographic severity and functional limitations were confirmed as drivers for TKA eligibility. Noteworthy, the OSs prioritised pain as the most important, functional limitations as the second most important and radiographic severity as the third most important criterion. So, it was expected that pain would be one of the most important predictor criteria, while this study highlighted that pain severity was not as important as other influencing criteria.
Furthermore, not responding to conservative treatment was not included in the decision-making, suggested a low uptake of clinical guidelines in clinical practice.
This study highlighted the complexity of the decision-making with some overlap between the criteria that OSs think they apply and what is actually applied in clinical practice.
> From: Skou et al., Knee 23 (2016) 300–305. All rights reserved to Elsevier Ltd. Click here for the Pubmed summary.