This article is more than 5 years old. Information may no longer be current.

Study: More than one-third of TKAs classified as inappropriate

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

More than a third of all total knee arthroplasties can be judged to be inappropriate, according to results of a study recently published in Arthritis & Rheumatology.

“Our finding that one-third of knee replacements were inappropriate was higher than expected and linked to variation in knee pain [osteoarthritis] OA severity and functional loss,” Daniel L. Riddle, PT, PhD, FAPTA, stated in a press release. “These data highlight the need to develop patient selection criteria in the United States.”

Discuss in OrthoMind

Riddle and colleagues studied patients who were enrolled in the Osteoarthritis Initiative. The study included 205 patients with a mean age of 67 years who underwent a total knee arthroplasty (TKA) over a 5-year period. Overall, the researchers had complete data for all the classification variables for 175 patients. They used a modified version of the RAND/UCLA-based appropriateness algorithm, as developed Escobar and colleagues, to classify the TKAs as appropriate, inconclusive or inappropriate. Classification was based on radiographic and knee motion and laxity measures, Kellgren and Lawrence (KL) scale values, age, and OARSI and WOMAC pain and function values.

Of all the procedures analyzed, researchers classified 44% as appropriate, 21.7% as inconclusive, and 34.3% as inappropriate. Of the cases classified as inappropriate, 24 (40%) were in a group of patients who had slight to moderate symptoms and KL grades of 3 or less while 15 (25%) were in patients who were 55 years or older with moderate symptoms and a KL grade of 4 in only one compartment.

“To my knowledge, ours is the first U.S. study to compare validated appropriateness criteria with actual cases of knee replacement surgery,” Riddle stated.

In a related editorial in the same issue, Jeffery N. Katz, MD, from the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston, stated, “I agree with Riddle and colleagues…that we should be concerned about offering total knee replacements to subjects who endorse ‘none’ or ‘mild’ on all items of the WOMAC pain and function scales.”

Reference:

Riddle DL. Arthritis & Rheum. 2014;doi:10.1002/art.38685

Disclosure: Katz is supported in part by a grant from the NIH (P60AR047782).