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[Indication for total knee arthroplasty: evidence mapping].

Elisabeth Haase1, Toni Lange1, Jörg Lützner2

  • 1Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland; UniversitätsCentrums für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland.

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Summary

There is no German guideline for total knee arthroplasty (TKA) indications. Further research is needed on TKA treatment goals, patient relevance, measurement, and predictors for successful outcomes.

Keywords:
EndoprotheseGonarthroseIndikationKnieOsteoarthritisTEPindicationkneereplacement

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Area of Science:

  • Orthopedic Surgery
  • Rheumatology
  • Health Economics

Background:

  • Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis in Germany.
  • Current lack of consensus on specific indication criteria for TKA.
  • Need for standardized guidelines in TKA surgery.

Purpose of the Study:

  • To investigate current practices and evidence regarding TKA indication criteria.
  • To analyze inclusion criteria in clinical trials for TKA.
  • To explore treatment goals, predictors, economic factors, and existing guidelines related to TKA.

Main Methods:

  • Systematic evidence mapping search of Medline, Cochrane Library, national guidelines, and AWMF portal.
  • Analysis of six guiding questions covering practice, trials, goals, predictors, economics, and guidelines.
  • Hand searching of selected journals and guideline repositories.

Main Results:

  • No consensus guideline for TKA indications currently exists in Germany.
  • Clinical trial criteria include knee osteoarthritis diagnosis, age, and BMI limits; common exclusions are inflammatory arthritis and allergies.
  • Limited studies on economic aspects of TKA indication and no comparable AWMF guidelines found.

Conclusions:

  • Systematic reviews are required to define TKA treatment goals, target populations, and outcome measures.
  • Further continuous analysis of predictors for positive TKA outcomes is recommended.
  • Establishment of clear, evidence-based indication criteria for TKA is crucial.