RT Journal Article
T1 Variability of indication criteria in knee and hip replacement: an observational study
A1 Cobos, Raquel
A1 Latorre, Amaia
A1 Aizpuru, Felipe
A1 Guenaga, Jose I
A1 Sarasqueta, Cristina
A1 Escobar, Antonio
A1 García, Lidia
A1 Herrera-Espiñeira, Carmen
K1 Anciano
K1 Artroplastia de Reemplazo de Cadera
K1 Artroplastia de Reemplazo de Rodilla
K1 Femenino
K1 Humanos
K1 Masculino
K1 Mediana Edad
K1 Variaciones Dependientes del Observador
K1 Pautas en la Práctica de los Médicos
K1 Estudios Prospectivos
AB BACKGROUND. Total knee (TKR) and hip (THR) replacement (arthroplasty) are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication.METHODS. The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated.The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95), variation coefficient (CV5-95) and weighted variation coefficient (WCV5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity.RESULTS. The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate-high variability was detected in subjective-objective signs. Among all the surgeries performed, approximately a quarter of them could be considered to be inappropriate.CONCLUSIONS. A greater inter-hospital variability was observed for objective than for subjective signs for both procedures, suggesting that the differences in clinical criteria followed by surgeons when indicating arthroplasty are the main responsible factors for the variation in surgery rates.
PB BioMed Central
SN 1471-2474
YR 2010
FD 2010-10-26
LK http://hdl.handle.net/10668/465
UL http://hdl.handle.net/10668/465
LA en
NO Cobos R ,Latorre A,  Aizpuru F, Guenaga JI, Sarasqueta C, Escobar A, et al. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord. 2010 Oct  26;11:249
NO Comparative Study; Evaluation Studies; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't;
DS RISalud
RD Apr 6, 2025