6533b86cfe1ef96bd12c8a9c
RESEARCH PRODUCT
Factors associated with the orthopaedic surgeon's decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1905 patients.
J.f. MaillefertJ. A. SinghLyn MarchKlaus-peter GüntherMaxime DougadosL PunziNizar N. MahomedL. Sanchez-rieraL.s. LohmanderC. HuynhEwa M. RoosLaure GossecAileen M. DavisKeith LimMargreet KloppenburgP. G. ConaghanGillian A. HawkerMaria E. Suarez-almazorMarc C. HochbergDéborah Puyraimond-zemmourKarel Pavelkasubject
MaleCross-sectional studymedicine.medical_treatmentArthroplasty Replacement HipOsteoarthritisappropriatenessSeverity of Illness IndexOsteoarthritis Hip0302 clinical medicineQuality of lifeperspectivespainOrthopedics and Sports Medicine030212 general & internal medicineProspective StudiesArthroplasty Replacement Kneeprimary-careOsteoarthritis Knee3. Good health[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal systemFemalemusculoskeletal diseasesmedicine.medical_specialtyWOMACDecision MakingBiomedical Engineering03 medical and health sciencesRheumatologyinequalitiesOsteoarthritisSeverity of illnessmedicineHumansKneeneedTotal joint replacementAged030203 arthritis & rheumatologydiseaseHipcriteriabusiness.industryOdds ratioOrthopedic Surgeonsmedicine.diseaseArthroplastyRadiographypredictorsCross-Sectional StudiesOrthopedic surgeryPhysical therapyQuality of LifearthroplastySurgerybusinessdescription
Summary Objective To determine factors associated with orthopaedic surgeons' decision to recommend total joint replacement (TJR) in people with knee and hip osteoarthritis (OA). Design Cross-sectional study in eleven countries. For consecutive outpatients with definite hip or knee OA consulting an orthopaedic surgeon, the surgeon's indication of TJR was collected, as well as patients' characteristics including comorbidities and social situation, OA symptom duration, pain, stiffness and function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), joint-specific quality of life, Osteoarthritis Research Society International (OARSI) joint space narrowing (JSN) radiographic grade (0–4), and surgeons' characteristics. Univariable and multivariable logistic regressions were performed to identify factors associated with the indication of TJR, adjusted by country. Results In total, 1905 patients were included: mean age was 66.5 (standard deviation [SD], 10.8) years, 1082 (58.0%) were women, mean OA symptom duration was 5.0 (SD 7.0) years. TJR was recommended in 561/1127 (49.8%) knee OA and 542/778 (69.7%) hip OA patients. In multivariable analysis on 516 patients with complete data, the variables associated with TJR indication were radiographic grade (Odds Ratio, OR for one grade increase, for knee and hip OA, respectively: 2.90, 95% confidence interval [1.69–4.97] and 3.30 [2.17–5.03]) and WOMAC total score (OR for 10 points increase: 1.65 [1.32–2.06] and 1.38 [1.15–1.66], respectively). After excluding radiographic grade from the analyses, on 1265 patients, greater WOMAC total score was the main predictor for knee and hip OA; older age was also significant for knee OA. Conclusion Radiographic severity and patient-reported pain and function play a major role in surgeons' recommendation for TJR.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2018-10-01 | Osteoarthritis and cartilage |