Z Orthop Unfall 2017; 155(05): 539-548
DOI: 10.1055/s-0043-115120
Aus den Sektionen – AE Deutsche Gesellschaft für Endoprothetik
Georg Thieme Verlag KG Stuttgart · New York

Indication Criteria for Total Knee Arthroplasty in Patients with Osteoarthritis – A Multi-perspective Consensus Study

Artikel in mehreren Sprachen: English | deutsch
Jochen Schmitt*
1   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden
,
Toni Lange*
1   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden
2   UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden
,
Klaus-Peter Günther
2   UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden
,
Christian Kopkow
1   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden
3   Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum
,
Elisabeth Rataj
1   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden
,
Christian Apfelbacher
4   Medizinische Soziologie, Institut für Epidemiologie und Präventivmedizin, Universitätsklinik Regensburg
,
Martin Aringer
5   Deutsche Gesellschaft für Rheumatologie e. V. (DGRh)
,
Eckhardt Böhle
6   Deutscher Verband für Physiotherapie e. V. (ZVK)
,
Hartmut Bork
7   Sektion Rehabilitation – Physikalische Therapie (DGOU)
,
Karsten Dreinhöfer
8   Orthopädie Berlin Humboldtmühle, Medical Park
,
Niklaus Friederich
9   Deutsche Arthrose-Hilfe e. V.
,
Karl-Heinz Frosch
10   Deutsche Gesellschaft für Unfallchirurgie e. V. (DGU)
11   Deutsche Kniegesellschaft e. V. (DKG)
,
Sascha Gravius
12   Deutsche Gesellschaft für Orthopädie und orthopädische Chirurgie e. V. (DGOOC)
,
Erika Gromnica-Ihle
13   Deutsche Rheuma-Liga Bundesverband e. V.
,
Karl-Dieter Heller
14   AE – Deutsche Gesellschaft für Endoprothetik e. V.
15   Berufsverband für Orthopädie und Unfallchirurgie e. V. (BVOU)
,
Stephan Kirschner
14   AE – Deutsche Gesellschaft für Endoprothetik e. V.
,
Bernd Kladny
16   Deutsche Gesellschaft für Orthopädie und Unfallchirurgie e. V. (DGOU)
,
Hendrik Kohlhof
12   Deutsche Gesellschaft für Orthopädie und orthopädische Chirurgie e. V. (DGOOC)
,
Michael Kremer
10   Deutsche Gesellschaft für Unfallchirurgie e. V. (DGU)
,
Nicolai Leuchten
5   Deutsche Gesellschaft für Rheumatologie e. V. (DGRh)
,
Maike Lippmann
17   Medizinische Psychologie und Medizinische Soziologie, Medizinische Fakultät Carl Gustav Carus, TU Dresden
,
Jürgen Malzahn
18   Abteilung Stationäre Versorgung, Rehabilitation, AOK Bundesverband, Berlin
,
Heiko Meyer
14   AE – Deutsche Gesellschaft für Endoprothetik e. V.
,
Rainer Sabatowski
19   Universitätsschmerzzentrum, Universitätsklinikum Carl Gustav Carus, TU Dresden
,
Hanns-Peter Scharf
20   Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim
,
Johannes Stoeve
12   Deutsche Gesellschaft für Orthopädie und orthopädische Chirurgie e. V. (DGOOC)
,
Richard Wagner
21   Deutsche Gesellschaft für Orthopädische Rheumatologie e. V. (DGORh)
,
Jörg Lützner
2   UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
19. Oktober 2017 (online)

Abstract

Background and Objectives Knee osteoarthritis (OA) is a significant public health burden. Rates of total knee arthroplasty (TKA) in OA vary substantially between geographical regions, most likely due to the lack of standardised indication criteria. We set out to define indication criteria for the German healthcare system for TKA in patients with knee OA, on the basis of best evidence and transparent multi-stakeholder consensus.

Methods We undertook a complex mixed methods study, including an iterative process of systematic appraisal of existing evidence, Delphi consensus methods and stakeholder conferences. We established a consensus panel representing key German national societies of healthcare providers (orthopaedic surgeons, rheumatologists, pain physicians, psychologists, physiotherapists), payers, and patient representatives. A priori defined consensus criteria were at least 70% agreement and less than 20% disagreement among the consensus panel. Agreement was sought for (1) core indication criteria defined as criteria that must be met to consider TKA in a normal patient with knee OA, (2) additional (not obligatory) indication criteria, (3) absolute contraindication criteria that generally prohibit TKA, and (4) risk factors that do not prohibit TKA, but usually do not lead to a recommendation for TKA.

Results The following 5 core indication criteria were agreed within the panel: 1. intermittent (several times per week) or constant knee pain for at least 3 – 6 months; 2. radiological confirmation of structural knee damage (osteoarthritis, osteonecrosis); 3. inadequate response to conservative treatment, including pharmacological and non-pharmacological treatment for at least 3 – 6 months; 4. adverse impact of knee disease on patientʼs quality of life for at least 3 – 6 months; 5. patient-reported suffering/impairment due to knee disease. Additional indication criteria, contraindication criteria, and risk factors for adverse outcome were also agreed by a large majority within the multi-perspective stakeholder panel.

Conclusion The defined indication criteria constitute a prerequisite for appropriate provision of TKA in patients with knee OA in Germany. In eligible patients, shared-decision making should eventually determine if TKA is performed or not. The next important steps are the implementation of the defined indication criteria, and the prospective investigation of predictors of success or failure of TKA in the context of routine care provision in Germany.

 
  • References/Literatur

  • 1 Moskowitz RW. The burden of osteoarthritis: clinical and quality-of-life issues. Am J Manag Care 2009; 15: S223-229
  • 2 Cross M, Smith E, Hoy D. et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73: 1323-1330
  • 3 Liddle AD, Pandit H, Judge A. et al. Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales. Bone Joint J 2015; 97-B: 793-801
  • 4 Carr AJ, Robertsson O, Graves S. et al. Knee replacement. Lancet 2012; 379: 1331-1340
  • 5 DESTATIS (Statistisches Bundesamt). Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik). In: Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern – Ausführliche Darstellung. 2015 Im Internet: https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/OperationenProzeduren5231401157014.pdf?__blob=publicationFile Stand: 16.05.2017
  • 6 Bourne RB, Chesworth BM, Davis AM. et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468: 57-63
  • 7 Dunbar MJ, Richardson G, Robertsson O. I canʼt get no satisfaction after my total knee replacement: rhymes and reasons. Bone Joint J 2013; 95-B: :148-152
  • 8 Scott CE, Howie CR, MacDonald D. et al. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 2010; 92: 1253-1258
  • 9 Dowsey MM, Spelman T, Choong PF. Development of a prognostic nomogram for predicting the probability of nonresponse to total knee arthroplasty 1 year after surgery. J Arthroplasty 2016; 31: 1654-1660
  • 10 Noble PC, Conditt MA, Cook KF. et al. The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 2006; 452: 35-43
  • 11 Haase E, Lange T, Lutzner J. et al. [Indication for total knee arthroplasty: evidence mapping]. Z Evid Fortbild Qual Gesundhwes 2015; 109: 605-614
  • 12 Cobos R, Latorre A, Aizpuru F. et al. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord 2010; 11: 249
  • 13 Gademan MG, Hofstede SN, Vliet Vlieland TP. et al. Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview. BMC Musculoskelet Disord 2016; 17: 463
  • 14 Lützner J, Schmitt J, Lange T. et al. Knietotalendoprothese: Wann ist der Ersatz angebracht?. Dtsch Arztebl Int 2016; 113: 1983-1985
  • 15 Schmucker CM, Motschall E, Antes G. et al. [Methods of evidence mapping. A systematic review]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56: 1390-1397
  • 16 Mancuso CA, Sculco TP, Wickiewicz TL. et al. Patientsʼ expectations of knee surgery. J Bone Joint Surg Am 2001; 83-A: 1005-1012
  • 17 Bedair H, Cha TD, Hansen VJ. Economic benefit to society at large of total knee arthroplasty in younger patients: a Markov analysis. J Bone Joint Surg Am 2014; 96: 119-126
  • 18 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6: e1000100
  • 19 Lange T, Rataj E, Kopkow C. et al. Outcome assessment in total knee arthroplasty: a systematic review and critical appraisal. J Arthroplasty 2017; 32: 653-665.e1
  • 20 Diamond IR, Grant RC, Feldman BM. et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 2014; 67: 401-409
  • 21 McKenna HP. The Delphi technique: a worthwhile research approach for nursing?. J Adv Nurs 1994; 19: 1221-1225
  • 22 Boulkedid R, Abdoul H, Loustau M. et al. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One 2011; 6: e20476
  • 23 Becker L, Oxman A. Chapter 22: Overviews of Reviews. In: Higgins J, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration. Im Internet: http://handbook-5-1.cochrane.org/ Stand: 16.05.2017
  • 24 Kopkow C, Schmitt J, Haase E. et al. [Objectifying results in total knee arthroplasty: is “patient satisfaction” adequate]. Orthopade 2015; 44: 261-264 266–268
  • 25 Pschyrembel W. Hrsg. Pschyrembel Klinisches Wörterbuch. Berlin: de Gruyter; 2007
  • 26 Klakow-Franck R. [Points of view: the role of quality measurement from the Federal Joint Committeeʼs perspective]. Z Evid Fortbild Qual Gesundhwes 2014; 108: 456-464
  • 27 Escobar A, Quintana J M, Aróstegui I. et al. Development of explicit criteria for total knee replacement. Int J Technol Assess Health Care 2003; 19: 57-70
  • 28 Hadorn DC, Holmes AC. The New Zealand priority criteria project. Part 1: overview. BMJ 1997; 314: 131-134
  • 29 Löfvendahl S, Bizjajeva S, Ranstam J. et al. Indications for hip and knee replacement in Sweden. J Eval Clin Pract 2011; 17: 251-260
  • 30 Günther K-P, Jeszenszky C, Schäfer T. et al. Hüft- und Kniegelenkersatz in Deutschland – Mythen und Fakten zur Operationshäufigkeit. Das Krankenhaus 2013; 9: 927-933
  • 31 Lüring C, Niethard FU, Günther KP. et al. Regionale Unterschiede und deren Einflussfaktoren – Schwerpunkt Knieendoprothetik. Gütersloh: Bertelsmann; 2013
  • 32 Niethard FU, Malzahn J, Schäfer T. Endoprothetik und Wirbelsäuleneingriffe: Uneinheitliches Versorgungsgeschehen. Dtsch Arztebl Int 2013; 110: 1362-1365
  • 33 Ackerman IN, Dieppe PA, March LM. et al. Variation in age and physical status prior to total knee and hip replacement surgery: a comparison of centers in Australia and Europe. Arthritis Rheum 2009; 61: 166-173
  • 34 Ramkumar PN, Harris JD, Noble PC. Patient-reported outcome measures after total knee arthroplasty: a systematic review. Bone Joint Res 2015; 4: 120-127
  • 35 Graf JM, Claes C, Greiner W. et al. Die deutsche Version des EuroQol-Fragebogens. Z f Gesundheitswiss 1998; 6: 3-20
  • 36 Bullinger M. German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med 1995; 41: 1359-1366