The Effect of Appropriateness of Indication on Patient Reported Outcomes of Total Knee Arthroplasty
Author(s):
Kaya Bicer Elcil (Turkey)
,
Kaya Bicer Elcil (Turkey)
Affiliations:
Sozbilen M.
,
Sozbilen M.
Affiliations:
Kayaokay K.
,
Kayaokay K.
Affiliations:
Aydogdu S.
,
Aydogdu S.
Affiliations:
Sur H.
Sur H.
Affiliations:
ESSKA Academy. KAYA BICER E. 05/09/18; 209609; P10-264 Topic: Joint Replacement
Elcil KAYA BICER
Elcil KAYA BICER
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Abstract
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Objectives: An algorithm was developed by Escobar et. al. in 2003 to evaluate appropriateness of total knee replacement (TKR) indications. Various studies which had been conducted to this time based on these algorithms pointed out that around one third of all TKRs were based on inappropriate indications. Our findings showed that less than half of the patients in our population were operated with an appropriate indication. To evaluate the patient reported outcomes following TKR with respect to appropriate, inappropriate, and uncertain indication groups and compare them with their preoperative status.

Methods: 100 knees of 98 patients with primary osteoarthritis consecutively operated between 2013 and 2015 were retrospectively evaluated regarding to aforementioned algorithm. Having history of previous knee surgery and patients undergone simultaneous bilateral TKR were excluded. 47 of the indications were grouped as appropriate, 41 as uncertain, and 12 as inappropriate.
In this study, the preoperative Knee injury and Osteoarthritis Outcome Scores (KOOS) of these patients were calculated based on self- filled subjective knee evaluation forms. Mean follow-up duration was 32.39 months. 82 patients (35 of them belonging to the appropriate group, 36 uncertain, and 11 inappropriate groups) were reached by phone and accepted to participate in this study. They were questioned on the phone and follow-up KOOS were calculated. Preoperative and follow-up scores as well as increments in the scores were compared between groups.
Statistical analyses were performed utilizing SPSS v 18. Multivariate analyses were conducted using ANOVA tests; for the post hoc analyses Bonferroni corrections were made. Significance level was set at 0.05.

Results: Preoperative KOOS were found to be significantly different among the three groups being lowest in appropriate group however highest in inappropriate (p<0.0001). Post hoc analysis revealed that differences between appropriate & inappropriate as well as appropriate & uncertain groups were significant (p values <0.0001). Follow-up scores of all three groups were higher compared to their preoperative status; however the difference between the groups was not significant (p=0.132).
The KOOS of the appropriate, inappropriate, and uncertain groups were increased from 41.29 ± 7.15 to 77.45 ± 8.52, 54.95 ± 4.27 to 81.25 ± 4.20, and 49.67 ± 8.87 to 80.94 ± 7.95, respectively. The comparison of the gains in the KOOS revealed that the highest increase was observed in the appropriate group. The differences among the three groups were significantly different (p=0.013). Increase of scores was significantly higher in appropriate group when compared to inappropriate (p=0.018).

Conclusions: The findings of this study showed that in our population based on patient reported outcomes the patients in the appropriate indication group obtained gains more than the others. This algorithm can be used to differentiate the ones who may benefit more than the others.

Keywords:
Knee replacement ; Arthroplasty; Osteoarthritis ; Appropriateness.
Objectives: An algorithm was developed by Escobar et. al. in 2003 to evaluate appropriateness of total knee replacement (TKR) indications. Various studies which had been conducted to this time based on these algorithms pointed out that around one third of all TKRs were based on inappropriate indications. Our findings showed that less than half of the patients in our population were operated with an appropriate indication. To evaluate the patient reported outcomes following TKR with respect to appropriate, inappropriate, and uncertain indication groups and compare them with their preoperative status.

Methods: 100 knees of 98 patients with primary osteoarthritis consecutively operated between 2013 and 2015 were retrospectively evaluated regarding to aforementioned algorithm. Having history of previous knee surgery and patients undergone simultaneous bilateral TKR were excluded. 47 of the indications were grouped as appropriate, 41 as uncertain, and 12 as inappropriate.
In this study, the preoperative Knee injury and Osteoarthritis Outcome Scores (KOOS) of these patients were calculated based on self- filled subjective knee evaluation forms. Mean follow-up duration was 32.39 months. 82 patients (35 of them belonging to the appropriate group, 36 uncertain, and 11 inappropriate groups) were reached by phone and accepted to participate in this study. They were questioned on the phone and follow-up KOOS were calculated. Preoperative and follow-up scores as well as increments in the scores were compared between groups.
Statistical analyses were performed utilizing SPSS v 18. Multivariate analyses were conducted using ANOVA tests; for the post hoc analyses Bonferroni corrections were made. Significance level was set at 0.05.

Results: Preoperative KOOS were found to be significantly different among the three groups being lowest in appropriate group however highest in inappropriate (p<0.0001). Post hoc analysis revealed that differences between appropriate & inappropriate as well as appropriate & uncertain groups were significant (p values <0.0001). Follow-up scores of all three groups were higher compared to their preoperative status; however the difference between the groups was not significant (p=0.132).
The KOOS of the appropriate, inappropriate, and uncertain groups were increased from 41.29 ± 7.15 to 77.45 ± 8.52, 54.95 ± 4.27 to 81.25 ± 4.20, and 49.67 ± 8.87 to 80.94 ± 7.95, respectively. The comparison of the gains in the KOOS revealed that the highest increase was observed in the appropriate group. The differences among the three groups were significantly different (p=0.013). Increase of scores was significantly higher in appropriate group when compared to inappropriate (p=0.018).

Conclusions: The findings of this study showed that in our population based on patient reported outcomes the patients in the appropriate indication group obtained gains more than the others. This algorithm can be used to differentiate the ones who may benefit more than the others.

Keywords:
Knee replacement ; Arthroplasty; Osteoarthritis ; Appropriateness.
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