PMID- 33781327 OWN - NLM STAT- MEDLINE DCOM- 20210916 LR - 20240331 IS - 1749-799X (Electronic) IS - 1749-799X (Linking) VI - 16 IP - 1 DP - 2021 Mar 29 TI - Validation of a second-generation appropriateness classification system for total knee arthroplasty: a prospective cohort study. PG - 227 LID - 10.1186/s13018-021-02371-z [doi] LID - 227 AB - BACKGROUND: To test the validity of a second-generation appropriateness system in a cohort of patients undergoing total knee arthroplasty (TKA). METHODS: 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. RESULTS: 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 < 0.001) and had greater improvements (i.e., journey scores) than those classified as Inappropriate (p < 0.001). At 6 months, destination scores for pain, function, or satisfaction were not significantly different across appropriateness categories. The percentage of patients meeting responder criteria (p < 0.001) and attaining MCID was statistically higher in Appropriate versus Inappropriate groups in pain (p = 0.04) and function (p = 0.004). CONCLUSIONS: 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. FAU - Escobar, Antonio AU - Escobar A AD - Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain. AD - Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain. AD - Kronikgune Institute for Health Services Research, Barakaldo, Spain. FAU - Bilbao, Amaia AU - Bilbao A AUID- ORCID: 0000-0002-2202-0753 AD - Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain. amaia.bilbaogonzalez@osakidetza.eus. AD - Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain. amaia.bilbaogonzalez@osakidetza.eus. AD - Kronikgune Institute for Health Services Research, Barakaldo, Spain. amaia.bilbaogonzalez@osakidetza.eus. FAU - Bertrand, Maria L AU - Bertrand ML AD - Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain. AD - University of Malaga, Malaga, Spain. AD - Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, Marbella, Spain. FAU - Moreta, Jesus AU - Moreta J AD - Biocruces-Bizkaia Health Research Institute, Group of Lower Limb Reconstructive Surgery, Barakaldo, Spain. AD - Osakidetza Basque Health Service, Department of Orthopaedic Surgery and Traumatology, Galdakao-Usansolo University Hospital, Galdakao, Spain. FAU - Froufe, Miquel A AU - Froufe MA AD - Department of Orthopaedic Surgery and Traumatology, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain. FAU - Colomina, Jordi AU - Colomina J AD - Department of Orthopaedic Surgery and Traumatology, Santa Maria University Hospital, Lleida, Spain. FAU - Martinez-Cruz, Olga AU - Martinez-Cruz O AD - Ambit d'Avaluacio, Agencia de Qualitat i Avaluacio Sanitaries de Catalunya (AQuAS), Departament de Salut - Generalitat de Catalunya, Barcelona, Spain. FAU - Perera, Robert A AU - Perera RA AD - Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA. FAU - Riddle, Daniel L AU - Riddle DL AD - Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, Richmond, VA, USA. LA - eng GR - PI15/01105/Instituto de Salud Carlos III/ GR - 2015111137/Departamento de Salud del Gobierno Vasco/ PT - Journal Article PT - Validation Study DEP - 20210329 PL - England TA - J Orthop Surg Res JT - Journal of orthopaedic surgery and research JID - 101265112 SB - IM MH - Aged MH - *Arthroplasty, Replacement, Knee MH - Female MH - Humans MH - Knee Joint/*surgery MH - Male MH - Middle Aged MH - Osteoarthritis, Knee/*classification/*surgery MH - Outcome Assessment, Health Care/*methods MH - Patient Satisfaction MH - Prospective Studies MH - Quality Assurance, Health Care/*methods MH - Quality of Life MH - Spain MH - Surveys and Questionnaires MH - Time Factors MH - Treatment Outcome PMC - PMC8006353 OTO - NOTNLM OT - Appropriateness OT - Knee OT - Osteoarthritis OT - Outcome measures OT - Quality of life OT - Surgery COIS- The authors declare that they have no competing interests. EDAT- 2021/03/31 06:00 MHDA- 2021/09/18 06:00 PMCR- 2021/03/29 CRDT- 2021/03/30 05:58 PHST- 2021/02/26 00:00 [received] PHST- 2021/03/21 00:00 [accepted] PHST- 2021/03/30 05:58 [entrez] PHST- 2021/03/31 06:00 [pubmed] PHST- 2021/09/18 06:00 [medline] PHST- 2021/03/29 00:00 [pmc-release] AID - 10.1186/s13018-021-02371-z [pii] AID - 2371 [pii] AID - 10.1186/s13018-021-02371-z [doi] PST - epublish SO - J Orthop Surg Res. 2021 Mar 29;16(1):227. doi: 10.1186/s13018-021-02371-z.