ArticleJournal of orthopaedic surgery and research2021
Validation of a second-generation appropriateness classification system for total knee arthroplasty: a prospective cohort study.
Article in Journal of orthopaedic surgery and research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 15 citations in OpenAlex.
- Comparison of definitions of early knee osteoarthritis for likelihood of progression at 2-year and 5-year follow-up: the Multicenter Osteoarthritis Study.Annals of the rheumatic diseases · 2025Article
- Lifetime Cost-Effectiveness of Structured Education and Exercise Therapy for Knee Osteoarthritis in Australia.JAMA network open · 2024Article
- Head-to-head comparison of appropriate use criteria for knee arthroplasty: A multicenter cohort study.Osteoarthritis and cartilage open · 2024Article
- Using Two Predictive Models to Capture Two Types of Poor Outcomes in Knee Arthroplasty: A Multisite Longitudinal Cohort Study.Arthritis & rheumatology (Hoboken, N.J.) · 2024Article
- Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome.RMD open · 2023Article
- Patellar retraction versus eversion on functional outcomes in total knee replacement: a randomized controlled study protocol.Journal of orthopaedic surgery and research · 2021Article
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Authors and funding
9 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundTo test the validity of a second-generation appropriateness system in a cohort of patients undergoing total knee arthroplasty (TKA).
methodsWe 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.
resultsA 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).
conclusionsThe 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.
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