%0 Journal Article
%A Escobar, Antonio
%A Bilbao, Amaia
%A Bertrand, Maria L
%A Moreta, Jesús
%A Froufe, Miquel A
%A Colomina, Jordi
%A Martınez-Cruz, Olga
%A Perera, Robert A
%A Riddle, Daniel L
%T Validation of a second-generation appropriateness classification system for total knee arthroplasty: a prospective cohort study.
%D 2021
%U http://hdl.handle.net/10668/17422
%X To test the validity of a second-generation appropriateness system in a cohort of patients undergoing total knee arthroplasty (TKA). We 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. A 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  The 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.
%K Appropriateness
%K Knee
%K Osteoarthritis
%K Outcome measures
%K Quality of life
%K Surgery
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