Schmitt, Jochen and Lange, Toni and Guenther, Klaus-Peter and Kopkow, Christian and Rataj, Elisabeth and Apfelbacher, Christian and Aringer, Martin and Boehle, Eckhardt and Bork, Hartmut and Dreinhoefer, Karsten and Friederich, Niklaus and Frosch, Karl-Heinz and Gravius, Sascha and Gromnica-Ihle, Erika and Heller, Karl-Dieter and Kirschner, Stephan and Kladny, Bernd and Kohlhof, Hendrik and Kremer, Michael and Leuchten, Nicolai and Lippmann, Maike and Malzahn, Juergen and Meyer, Heiko and Sabatowski, Rainer and Scharf, Hanns-Peter and Stoeve, Johannes and Wagner, Richard and Luetzner, Joerg (2017) Indication Criteria for Total Knee Arthroplasty in Patients with Osteoarthritis - A Multi-perspective Consensus Study. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE, 155 (5). pp. 539-548. ISSN 1864-6697, 1864-6743
Full text not available from this repository. (Request a copy)Abstract
Background and Objectives Knee osteoarthritis (OA) is a significant public health burden. Rates of total knee arthroplasty (TKA) in OA vary substantially between geographical regions, most likely due to the lack of standardised indication criteria. We set out to define indication criteria for the German healthcare system for TKA in patients with knee OA, on the basis of best evidence and transparent multi-stakeholder consensus. Methods We undertook a complex mixed methods study, including an iterative process of systematic appraisal of existing evidence, Delphi consensus methods and stakeholder conferences. We established a consensus panel representing key German national societies of healthcare providers (orthopaedic surgeons, rheumatologists, pain physicians, psychologists, physiotherapists), payers, and patient representatives. A priori defined consensus criteria were at least 70% agreement and less than 20% disagreement among the consensus panel. Agreement was sought for (1) core indication criteria defined as criteria that must be met to consider TKA in a normal patient with knee OA, (2) additional (not obligatory) indication criteria, (3) absolute contraindication criteria that generally prohibit TKA, and (4) risk factors that do not prohibit TKA, but usually do not lead to a recommendation for TKA. Results The following 5 core indication criteria were agreed within the panel: 1. intermittent (several times per week) or constant knee pain for at least 3-6 months; 2. radiological confirmation of structural knee damage (osteoarthritis, osteonecrosis); 3. inadequate response to conservative treatment, including pharmacological and non-pharmacological treatment for at least 3-6 months; 4. adverse impact of knee disease on patient's quality of life for at least 3-6 months; 5. patient-reported suffering/impairment due to knee disease. Additional indication criteria, contraindication criteria, and risk factors for adverse outcome were also agreed by a large majority within the multi-perspective stakeholder panel. Conclusion The defined indication criteria constitute a prerequisite for appropriate provision of TKA in patients with knee OA in Germany. In eligible patients, shared-decision making should eventually determine if TKA is performed or not. The next important steps are the implementation of the defined indication criteria, and the prospective investigation of predictors of success or failure of TKA in the context of routine care provision in Germany.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | REPLACEMENT; HIP; SATISFACTION; SURGERY; EXPECTATIONS; PROJECT; DELPHI; knee osteoarthritis; total knee arthroplasty; indication; consensus; evidence |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Institut für Epidemiologie und Präventivmedizin > Medical Sociology |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 14 Dec 2018 13:19 |
| Last Modified: | 01 Mar 2019 08:23 |
| URI: | https://pred.uni-regensburg.de/id/eprint/2119 |
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