Indication Criteria for Total Knee Arthroplasty in Patients with Osteoarthritis - A Multi-perspective Consensus Study
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Indication Criteria for Total Knee Arthroplasty in Patients with Osteoarthritis - A Multi-perspective Consensus Study. / Schmitt, Jochen; Lange, Toni; Günther, Klaus-Peter; Kopkow, Christian; Rataj, Elisabeth; Apfelbacher, Christian; Aringer, Martin; Böhle, Eckhardt; Bork, Hartmut; Dreinhöfer, Karsten; Friederich, Niklaus; Frosch, Karl-Heinz; Gravius, Sascha; Gromnica-Ihle, Erika; Heller, Karl-Dieter; Kirschner, Stephan; Kladny, Bernd; Kohlhof, Hendrik; Kremer, Michael; Leuchten, Nicolai; Lippmann, Maike; Malzahn, Jürgen; Meyer, Heiko; Sabatowski, Rainer; Scharf, Hanns-Peter; Stoeve, Johannes; Wagner, Richard; Lützner, Jörg.
In: Z ORTHOP UNFALLCHIR, Vol. 155, No. 5, 10.2017, p. 539-548.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Indication Criteria for Total Knee Arthroplasty in Patients with Osteoarthritis - A Multi-perspective Consensus Study
AU - Schmitt, Jochen
AU - Lange, Toni
AU - Günther, Klaus-Peter
AU - Kopkow, Christian
AU - Rataj, Elisabeth
AU - Apfelbacher, Christian
AU - Aringer, Martin
AU - Böhle, Eckhardt
AU - Bork, Hartmut
AU - Dreinhöfer, Karsten
AU - Friederich, Niklaus
AU - Frosch, Karl-Heinz
AU - Gravius, Sascha
AU - Gromnica-Ihle, Erika
AU - Heller, Karl-Dieter
AU - Kirschner, Stephan
AU - Kladny, Bernd
AU - Kohlhof, Hendrik
AU - Kremer, Michael
AU - Leuchten, Nicolai
AU - Lippmann, Maike
AU - Malzahn, Jürgen
AU - Meyer, Heiko
AU - Sabatowski, Rainer
AU - Scharf, Hanns-Peter
AU - Stoeve, Johannes
AU - Wagner, Richard
AU - Lützner, Jörg
N1 - Georg Thieme Verlag KG Stuttgart · New York.
PY - 2017/10
Y1 - 2017/10
N2 - 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.
AB - 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.
KW - Arthroplasty, Replacement, Knee
KW - Consensus
KW - Evidence-Based Medicine
KW - Germany
KW - Humans
KW - National Health Programs
KW - Osteoarthritis, Knee
KW - Journal Article
U2 - 10.1055/s-0043-115120
DO - 10.1055/s-0043-115120
M3 - SCORING: Journal article
C2 - 29050054
VL - 155
SP - 539
EP - 548
JO - Z ORTHOP UNFALLCHIR
JF - Z ORTHOP UNFALLCHIR
SN - 1864-6697
IS - 5
ER -