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Pacheco-Brousseau L, Stacey D, Desmeules F, Ben Amor S, Lambert D, Tanguay E, Hillaby A, Bechiau C, Charette M, Poitras S. Instruments to assess appropriateness of hip and knee arthroplasty: a systematic review. Osteoarthritis Cartilage 2023:S1063-4584(23)00701-X. [PMID: 36898655 DOI: 10.1016/j.joca.2023.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To assess criteria and psychometric properties of instruments for assessing appropriateness of elective joint arthroplasty (JA) for adults with primary hip and knee osteoarthritis (OA). METHODS A systematic review guided by Cochrane methods and PRISMA guidelines. Studies were searched in five databases. Eligible articles include all study designs developing, testing, and/or using an instrument to assess JA appropriateness. Two independent reviewers screened and extracted data. Instruments were compared with Hawker et al. JA consensus criteria. Psychometric properties of instruments were described and appraised guided by Fitzpatrick's and COSMIN approaches. RESULTS Of 55 instruments included, none met all Hawker et al. JA consensus criteria. Criteria the most met were pain (n = 50), function (n = 49), quality of life (n = 33), and radiography (n = 24). Criteria the least met were clinical evidence of OA (n = 18), expectations (n = 15), readiness for surgery (n = 11), conservative treatments (n = 8), and patient/surgeon agree benefits outweigh risks (n = 0). Instrument by Arden et al. met the most criteria (6 of 9). The most tested psychometric properties were appropriateness (n = 55), face/content validity (n = 55), predictive validity (n = 29), construct validity and feasibility (n = 24). The least tested psychometric properties were intra-rater reliability (n = 3), internal consistency (n = 5), and inter-rater reliability (n = 13). Instruments by Gutacker et al. and Osborne et al. met the most psychometric properties (4 of 10). CONCLUSION Most instruments included traditional criteria for assessing JA appropriateness but did not include a trial of conservative treatments or shared decision-making elements. There was limited evidence on psychometric properties.
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Affiliation(s)
- L Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - D Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - F Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montréal, Canada.
| | - S Ben Amor
- Telfer School of Management, University of Ottawa, Ottawa, Canada.
| | - D Lambert
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - E Tanguay
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - A Hillaby
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - C Bechiau
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.
| | - M Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - S Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
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Nganga M, Bramwell D, Monaghan J, Doerr C, Mercer G, Krishnan J. Evaluation of the Multi-Attribute Prioritisation Tool for Total Joint Replacement. J Orthop 2018; 15:242-247. [PMID: 29657477 DOI: 10.1016/j.jor.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/12/2018] [Indexed: 11/19/2022] Open
Abstract
Rationale aims and objectives The demand for arthroplasty is increasing and will continue to rise with an ageing population. Obesity and lengthy waiting time for Total Joint Replacement (TJR) have been associated with poorer outcomes postoperatively. This study aimed to evaluate the Multi-Attribute Prioritisation Tool (MAPT) for TJR patients. The primary objective was to explore if patients prioritised by the MAPT had an improvement in score post-operative. Further to identify any relationship between MAPT score and length of time on the waiting list or obesity. Method This retrospective cohort study included 308 patients undergoing total hip (n = 114) or total knee (n = 194) arthroplasty. We examined preoperative and postoperative MAPT scores of patients who had total hip or total knee arthroplasty. After assessing the difference between postoperative and preoperative MAPT scores, patients scores were compared to BMI and waiting time classes. BMI was allocated to less than 30, 30-35, 35-40 and greater than 40. Duration of time on the waiting list was allocated to less than 6 months and greater than 6 months. Results THA and TKA patients MAPT scores improved from a preoperative score of 71.39-5.26 postoperative and 54.11 to 7.13 respectively. Patients whose MAPT scores placed them in the high priority category had a significant relationship with length of time on the waiting list (p < 0.01). There were no significant differences between length of time on the waiting list and improvement scores for low priority and middle priority patients. BMI had minimal effect on patients improvement score postoperative. Conclusion TJR patients prioritised by the MAPT questionnaire do experience pain relief as portrayed by a reduction in postoperative MAPT score. A longer length of time on the waiting list seems to effect the improvement a high priority patient can have postoperative.
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Affiliation(s)
- Michael Nganga
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The International Musculoskeletal Research Institute Inc., Adelaide, South Australia, Australia
| | - Donald Bramwell
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The International Musculoskeletal Research Institute Inc., Adelaide, South Australia, Australia
| | - Jenifer Monaghan
- Department of Orthopaedics, Repatriation General Hospital, Adelaide, South Australia, Australia
| | - Christine Doerr
- Department of Orthopaedics, Repatriation General Hospital, Adelaide, South Australia, Australia
| | - Graham Mercer
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Orthopaedics, Repatriation General Hospital, Adelaide, South Australia, Australia
| | - Jeganath Krishnan
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The International Musculoskeletal Research Institute Inc., Adelaide, South Australia, Australia
- Department of Orthopaedic Surgery & Trauma, Flinders Medical Centre, Adelaide, South Australia, Australia
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Dowsey MM, Gunn J, Choong PFM. Selecting those to refer for joint replacement: who will likely benefit and who will not? Best Pract Res Clin Rheumatol 2014; 28:157-71. [PMID: 24792950 DOI: 10.1016/j.berh.2014.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Osteoarthritis (OA) is one of the 10 most disabling diseases in developed countries and worldwide estimates are that 10% of men and 18% of women aged over 60 years have symptomatic OA, including moderate and severe forms. Total joint replacement (TJR) is considered the most effective treatment for end-stage OA in those who have exhausted available conservative interventions. The demand for TJR is continually rising due to the ageing population; in the United States, more than 1 million TJRs were performed in 2010 and the number of procedures is projected to exceed 4 million in the US by 2030. It has been estimated that of all hip and knee replacements performed, approximately one quarter of the patients may be considered inappropriate candidates. Predicting who will benefit from TJR and who will not would seem critical in terms of containing the current and projected expenditure as well as improving satisfaction in TJR recipients. Few formal predictive tools are available to aid referring clinicians to determine those likely to be good or poor responders to surgery and current available tools tend to focus on disease severity alone with little consideration of risk factors that may predict a poor outcome or impede an effective response to surgery. This review examines the tools available to assist with assessing appropriateness for TJR; investigates the modifiable risk factors associated with poor outcome; and identifies areas for future research in selecting those appropriate for joint replacement.
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Affiliation(s)
- Michelle M Dowsey
- The University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, 29 Regent Street, Fitzroy, Victoria, 3065, Australia; St. Vincent's Hospital Melbourne, Department of Orthopaedics, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
| | - Jane Gunn
- The University of Melbourne, Department of General Practice, 200 Berkeley Street, Carlton, Victoria, 3053, Australia.
| | - Peter F M Choong
- The University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, 29 Regent Street, Fitzroy, Victoria, 3065, Australia; St. Vincent's Hospital Melbourne, Department of Orthopaedics, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
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