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- W2936704063 abstract "Purpose: The American Academy of Orthopaedic Surgeons (AAOS) published an appropriateness classification system using the RAND/UCLA approach for patients with hip osteoarthritis (OA) in late 2017. We determined the contribution of all predictor variables in the system to final classification, rated as “appropriate,” “may be appropriate” or “rarely appropriate” for hip arthroplasty. Methods: An AAOS appointed expert panel developed 270 clinical vignettes incorporating all possible combinations of five evidence-driven indication variables associated with hip arthroplasty outcome or need. An independent AAOS appointed expert panel rated the appropriateness of each vignette for hip arthroplasty. The vignettes and a public use user friendly application have been distributed by the AAOS to facilitate clinical uptake. Indication variables were age, function-limiting pain severity, radiographic hip OA severity, hip motion and presence of modifiable prognostic risk factors. We used the entire population of vignettes in a multinomial regression to determine the relative contribution of each variable. In addition, we used a classification tree method to determine indication variable combinations contributing to final classification. Results: Patient age and hip OA severity were the dominant predictors of appropriateness classification in both statistical models. Function-limiting pain made a slight contribution relative to age and hip OA severity while hip motion and the presence of modifiable prognostic factors did not meaningfully contribute to final classification. The regression model explained approximately 99% of the variance and the classification tree had an accuracy of 87.8%. Conclusions: Classification for hip arthroplasty appropriateness in the AAOS system is driven almost exclusively by age and OA severity. Function-limiting pain, a major reason patients seek surgery contributes only slightly to the AAOS appropriateness criteria and modifiable prognostic risk factors did not make a meaningful contribution to classification. Future study of actual patient outcomes is needed to further test the validity of the AAOS system." @default.
- W2936704063 created "2019-04-25" @default.
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- W2936704063 date "2019-04-01" @default.
- W2936704063 modified "2023-09-30" @default.
- W2936704063 title "Examination of the American academy of orthopaedic surgeons system for classifying appropriateness of hip arthroplasty" @default.
- W2936704063 doi "https://doi.org/10.1016/j.joca.2019.02.586" @default.
- W2936704063 hasPublicationYear "2019" @default.
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