Skou Søren T, Roos Ewa M, Laursen Mogens B, Rathleff Michael S, Arendt-Nielsen Lars, Simonsen Ole, Rasmussen Sten
Orthopaedic Surgery Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark; Clinical Nursing Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark.
Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark.
Knee. 2016 Mar;23(2):300-5. doi: 10.1016/j.knee.2015.08.012. Epub 2015 Dec 31.
Clinical decision-making in total knee arthroplasty (TKA) is a complex process needing further clarification. The aim of this study was to compare TKA eligibility criteria considered most important by orthopedic surgeons (OSs) to characteristics of patients with knee osteoarthritis (OA) eventually found eligible for TKA.
Nine OSs chose the five criteria most important when deciding on TKA eligibility. Cross-sectional data from 200 patients found either eligible (n=100) or not eligible (n=100) for TKA by one of the nine OS, were analyzed in a regression analyses with TKA eligibility as the dependent variable.
Radiographic severity (n=8), pain (n=9), functional disability (n=8) and not responding to the recommended non-surgical treatment (n=7) were considered most important by OSs. Associations (P<0.25) between TKA eligibility and criteria found important by the OS were demonstrated for worse radiographic severity and more functional limitations, but not for pain and not responding to the recommended non-surgical treatment. Furthermore, more comorbidities and higher Body Mass Index (BMI) were associated with TKA-eligibility, but not found important for TKA eligibility by the OS.
Radiographic severity and functional limitations were confirmed as drivers for TKA eligibility, while pain was not. Not responding to non-surgical treatment was not included in the decision-making, suggesting low uptake of clinical guidelines in clinical practice. This study highlights the complexity of the decision-making with some overlap between the criteria that OSs think they apply and what is actually applied in clinical practice.
全膝关节置换术（TKA）的临床决策是一个复杂的过程，需要进一步阐明。本研究的目的是比较骨科医生（OSs）认为最重要的TKA资格标准与最终被认定符合TKA资格的膝骨关节炎（OA）患者的特征。
9名骨科医生选择了决定TKA资格时最重要的5项标准。对9名骨科医生之一判定为符合（n = 100）或不符合（n = 100）TKA资格的200例患者的横断面数据进行回归分析，以TKA资格作为因变量。
骨科医生认为最重要的标准是影像学严重程度（n = 8）、疼痛（n = 9）、功能障碍（n = 8）和对推荐的非手术治疗无反应（n = 7）。影像学严重程度越差和功能受限越多，显示出TKA资格与骨科医生认为重要的标准之间存在关联（P < 0.25），但疼痛和对推荐的非手术治疗无反应则无此关联。此外，更多的合并症和更高的体重指数（BMI）与TKA资格相关，但骨科医生认为这些对TKA资格并不重要。
影像学严重程度和功能受限被确认为TKA资格的驱动因素，而疼痛则不是。非手术治疗无反应未纳入决策过程，这表明临床实践中对临床指南的采纳率较低。本研究强调了决策的复杂性，骨科医生认为他们应用的标准与临床实践中实际应用的标准之间存在一些重叠。
