Kronikgune, Baracaldo, Spain, Hospital Universitario Basurto-Health Services and Chronic Diseases Research Network (REDISSEC, Bilbao, Spain.
Virginia Commonwealth University, Richmond.
Arthritis Care Res (Hoboken). 2021 Jun;73(6):801-809. doi: 10.1002/acr.24169.
Evidence supports the validity of total knee arthroplasty (TKA) appropriateness classification based on the RAND Corporation and University of California Los Angeles system.The system, however, is ~2 decades old, and the science and clinical application of TKA has changed dramatically. We undertook this study to describe the methods used to develop a second-generation system and to examine the structure of the system to determine the extent to which each of the indication criteria informed appropriateness.
Multivariable multinomial regression analyses determined the extent to which each of the 8 individually analyzed indication criteria informed appropriateness judgments. Classification tree analysis illustrates how the indication criteria, in combination, led to judgments of appropriate, inappropriate, or uncertain.
An expert panel selected 8 indication criteria (i.e., age, knee pain, function, radiographic osteoarthritis severity, osteoarthritis location, psychological factors, pain catastrophizing, and comorbidities). A total of 1,008 clinical scenarios were written, based on the criteria. Regression analyses indicated that age, knee pain, function, and radiographic severity dominated prediction of appropriateness, while the other criteria played a smaller role. Classification tree analysis confirmed the regression findings.
Our second-generation classification system, which incorporates contemporary indicators of TKA prognosis and risk, demonstrated preliminary evidence for utility in clinical practice.
有证据支持基于 RAND 公司和加利福尼亚大学洛杉矶分校系统的全膝关节置换术（TKA）适宜性分类的有效性。然而，该系统已有约 20 年的历史，TKA 的科学和临床应用已经发生了巨大变化。我们进行这项研究是为了描述开发第二代系统所使用的方法，并检查系统的结构，以确定每个适应证标准在多大程度上影响适宜性判断。
多变量多项回归分析确定了 8 个单独分析的适应证标准在多大程度上影响适宜性判断。分类树分析说明了适应证标准如何结合起来导致适宜、不适宜或不确定的判断。
一个专家小组选择了 8 个适应证标准（即年龄、膝关节疼痛、功能、影像学骨关节炎严重程度、骨关节炎位置、心理因素、疼痛灾难化和合并症）。根据这些标准共编写了 1008 个临床情景。回归分析表明，年龄、膝关节疼痛、功能和影像学严重程度主导着适宜性的预测，而其他标准的作用较小。分类树分析证实了回归分析的结果。
我们的第二代分类系统纳入了 TKA 预后和风险的当代指标，初步证明了其在临床实践中的实用性。
