Knee replacement surgery for osteoarthritis: effectiveness, practice variations, indications and possible determinants of utilization

Dieppe, Paul; Basler, Heinz-Dieter; Chard, Jiri; Croft, Peter; Dixon, John; Hurley, Mike; Lohmander, L. Stefan; Raspe, H.

doi:10.1093/rheumatology/38.1.73

Cited by 198 publications

(132 citation statements)

References 6 publications

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“…The reason for this difference may simply be that in the present review none of the studies reporting the relationship between radiologic severity and progression of knee OA used total knee replacement as an outcome measure, whereas in the review by Lievense et al (5) a total hip replacement was often used as an outcome, and radiologic severity was one of the indicators for a subsequent total hip or knee replacement (46).…”

Section: Discussionmentioning

confidence: 74%

Prognostic factors of progression of osteoarthritis of the knee: A systematic review of observational studies

Belo¹,

Berger²,

Reijman³

et al. 2007

Arthritis & Rheumatism

167

132

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Objective. To provide an overview of prognostic factors of knee osteoarthritis (OA) progression. Methods. We searched Medline and Embase up to December 2003 according to a specified search strategy (keywords for disease, location, and study design). Studies that fulfilled predefined criteria were assessed for methodologic quality. Study characteristics and associations were extracted and the results were summarized according to a best evidence synthesis. Results. Of the 1,004 studies found, 37 met the inclusion criteria. Methodologic quality was assessed and only highquality studies were included (n ‫؍‬ 36). The best evidence synthesis yielded strong evidence that hyaluronic acid serum levels and generalized OA are predictive for progression of knee OA. Sex, knee pain, radiologic severity, knee injury, quadriceps strength, and regular sport activities were not predictive. Conflicting evidence for associations was found for several factors including body mass index and age. Limited evidence for an association with progression of knee OA was found for several factors, including the alignment (varus/valgus) of the joint. Limited evidence for no association with progression of OA was also found for several factors, including meniscectomy, several markers of bone or cartilage turnover, and the clinical diagnosis of localized OA. Conclusion. Generalized OA and level of hyaluronic acid seem to be associated with the radiologic progression of knee OA. Knee pain, radiologic severity at baseline, sex, quadriceps strength, knee injury, and regular sport activities seem not to be related. For other factors, the evidence was limited or conflicting.

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Section: Discussionmentioning

confidence: 74%

Prognostic factors of progression of osteoarthritis of the knee: A systematic review of observational studies

Belo¹,

Berger²,

Reijman³

et al. 2007

Arthritis & Rheumatism

167

132

View full text Add to dashboard Cite

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“…There are few RCTs of any orthopedic intervention in patients with arthritis, even for common procedures such as knee replacement (45). Many surgeons have concerns about RCTs in surgery, because outcomes are operator dependent and appropriate controls (e.g., "sham" operations) are problematic.…”

Section: Discussionmentioning

confidence: 99%

Interventions for foot disease in rheumatoid arthritis: A systematic review

2005

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Objective. To systematically review medical and surgical foot intervention studies in rheumatoid arthritis (RA), focusing on clinical efficacy, study quality, and risk of harm. Methods. We searched appropriate databases using a combination of the terms "rheumatoid arthritis" and "foot" against terms indicating treatment; we also hand-searched references. We selected articles in English (1968 -2003) comprising randomized controlled trials (RCTs), controlled clinical trials (CCTs), prospective observational studies, and large retrospective observational surgical studies (>50 cases). RCT quality was examined using Jadad scoring; other designs were assessed qualitatively. Results. Inclusion criteria were met by 33 of 894 identified studies, comprising 5 RCTs and 1 CCT (all nonsurgical), 15 prospective observational studies (8 nonsurgical, 7 surgical), and 12 large retrospective studies (all surgical). Functional, custom-designed and semirigid orthoses and extra-depth shoes were effective in single RCTs of variable quality; no comparative studies have been conducted. This finding was supported by a CCT and prospective observational studies. There was no evidence of harm. There were no controlled trials of surgery. Prospective observational studies suggest that forefoot arthroplasty and first metatarsophalangeal joint implants, but not plantar callous debridement, are effective. Comparative retrospective analyses suggest that some procedure variants may be better, and surgery may relieve pain better than orthoses. Infection was the main risk. Conclusion. RCT evidence shows that orthoses and special shoes are likely to be beneficial in patients with RA. The only evidence of benefit from surgery comes from observational studies, because no RCTs have been conducted. Further RCT evidence is needed, although well-designed observational studies may be helpful.

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“…Total hip (THA) and total knee (TKA) arthroplasties are cost-effective interventions for reducing pain, improving function, and enhancing the quality of life in patients with arthritis of the hip and knee (1,2). More than 193,000 THA and 381,000 TKA procedures are performed in the US each year (3), and future projections indicate that by the year 2030, more than 750,000 of these procedures will be performed per year (4).…”

Section: Introductionmentioning

confidence: 99%