RT Journal Article
T1 Validation of a second-generation appropriateness classification system for total knee arthroplasty: a prospective cohort study.
A1 Escobar, Antonio
A1 Bilbao, Amaia
A1 Bertrand, Maria L
A1 Moreta, Jesús
A1 Froufe, Miquel A
A1 Colomina, Jordi
A1 Martınez-Cruz, Olga
A1 Perera, Robert A
A1 Riddle, Daniel L
K1 Appropriateness
K1 Knee
K1 Osteoarthritis
K1 Outcome measures
K1 Quality of life
K1 Surgery
AB 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.
YR 2021
FD 2021-03-29
LK http://hdl.handle.net/10668/17422
UL http://hdl.handle.net/10668/17422
LA en
DS RISalud
RD Apr 13, 2025