Abstract
BackgroundThis systematic review gives an overview of guidelines and original publications as well as the evidence on which the currently proposed indication criteria are based. Until now such a state-of-the-science overview was lacking.MethodsWebsites of orthopaedic and arthritis organizations (English/Dutch language) were independently searched by two authors for THA/TKA guidelines for OA. Furthermore, a systematic search strategy in several databases through August 2014 was performed. Quality of the guidelines was assessed with the AGREE II instrument, which consists of 6 domains (maximum summed score of 6 indicating high quality). Also, the level of evidence of all included studies was assessed.ResultsWe found 6 guidelines and 18 papers, out of 3065 references. The quality of the guidelines summed across 6 domains ranged from 0.46 to 4.78. In total, 12 THA, 10 TKA and 2 THA/TKA indication sets were found. Four studies stated that no evidence-based indication criteria are available. Indication criteria concerning THA/TKA consisted of the following domains: pain (in respectively 11 and 10 sets), function (12 and 7 sets), radiological changes (10 and 9 sets), failed conservative therapy (8 and 4 sets) and other indications (6 and 7 sets). Specific cut-off values or ranges were often not stated and the level of evidence was low.ConclusionThe indication criteria for THA/TKA are based on limited evidence. Empirical research is needed, especially regarding domain specific cut-off values or ranges at which the best postoperative outcomes are achieved for patients, taking into account the limited lifespan of a prosthesis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1325-z) contains supplementary material, which is available to authorized users.
Highlights
This systematic review gives an overview of guidelines and original publications as well as the evidence on which the currently proposed indication criteria are based
Indication criteria concerning Total hip arthroplasty (THA) and Total knee arthroplasty (TKA) Most indication criteria consisted of the following three domains: pain, function and radiological changes, with the prerequisite that pain could not be controlled by conservative therapy (Table 1)
The evidence on which the indication criteria were based was rated as low quality evidence
Summary
This systematic review gives an overview of guidelines and original publications as well as the evidence on which the currently proposed indication criteria are based. Until now such a state-of-the-science overview was lacking. Large heterogeneity exists in the patients disease severity at the time of surgery [6, 7]. This can partly be explained by the patient’s own wishes, with some patients preferring a THA/TKA to continue an active lifestyle whereas others request surgery to be able to perform daily living activities. The attitude of the surgeon towards arthroplasty plays an important role since surgeons with a positive attitude
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