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Preoperative pain and function profiles reflect consistent TKA patient selection among US surgeons
David C Ayers1, Wenjun Li, Leslie Harrold
1Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA, david.ayers@umassmemorial.org.
Clinical Orthopaedics and Related Research
|June 25, 2014
Summary
Surgeons use consistent criteria for scheduling total knee arthroplasty (TKA), indicating that patients experience significant pain and disability before surgery. This consistency suggests TKA is performed when medically necessary.
Area of Science:
- Orthopedic Surgery
- Biostatistics
- Health Services Research
Background:
- The number of primary total knee arthroplasties (TKAs) is increasing in the US.
- Policymakers question if TKA indications and timing have shifted towards earlier surgical intervention.
- This study investigates surgeon selection criteria for TKA.
Purpose of the Study:
- To analyze a US national TKA cohort.
- To evaluate variations in surgeon selection criteria for elective unilateral TKA.
- To assess criteria based on preoperative patient-reported pain and function scores.
Main Methods:
- Utilized data from 4900 patients undergoing elective unilateral TKA across 22 states.
- Evaluated preoperative SF-36 (Physical Component Summary/physical function) and KOOS (pain, function) scores.
- Compared percentile pain and function scores across 24 orthopaedic offices to assess consistency.
Main Results:
- Patients undergoing TKA reported substantial disability, with function scores significantly below national norms.
- Preoperative SF-36 PCS median was 32.6 (national norm 50), and KOOS median was 51.5 (max 100).
- High consistency was observed across 24 surgeon offices, with site-specific medians varying minimally.
Conclusions:
- Surgeons at participating sites demonstrate consistent patient selection criteria for TKA.
- Current TKA patients report significant pain and functional disability, justifying the need for surgery.
- Despite increased TKA use, criteria appear stable and patient-centered.
