Utilization of American Academy of Orthopedic Surgeons (AAOS) Appropriate Use Criteria for Non-Arthroplasty treatment of knee osteoarthritis in clinical practice. Does it imitate reality?

Abstract

Objective: This study aimed to assess the use of Appropriate Use Criteria (AUC) by comparing the non-arthroplasty treatment of knee OA in our hospital with the AUC recommendations.

Methods: The AUC for Non-Arthroplasty treatment of Knee Osteoarthritis (OA) was developed to help physicians in making evidence-based treatment for knee OA. A Retrospective review of the medical charts and radiographs of all adult patients with knee OA from August to November 2018 was conducted. We collected data for age, gender, pain level, mechanical symptoms, ROM, ligamentous instability, radiographic pattern and severity, limb alignment, and the treatments. The data entered in the AUC application to assess its use and the rate of the treatment’s appropriateness. We then compared the actual treatment provided with AUC recommendations to assess the agreement between both.

Results: 150 patients with a mean age of 55.7 years (34-86years) and 67% female were treated at the knee clinic. 61(11%) scenarios were observed. The most common scenario (17.3%) was a middle-aged female with function- limiting pain at moderate to long-distance without mechanical symptoms, normal limb alignment, full range of motion, no ligamentous instability with mild to moderate joint space loss involving one compartment. The overall rate of the appropriate treatment and in agreement with the AUC recommendations was 95.7%, may be appropriate in 4.2% and rarely appropriate in 0.1%.  The appropriate treatment was in agreement with the AUC recommendations for self-management, physical therapy, and NSAIDs in 100%, acetaminophen in 92.5%, and Intra-articular steroid in 45.5%.

Conclusions: This study showed that the non-arthroplasty treatments of knee OA were appropriate in most cases. However, the agreement with AUC recommendations was observed in a few treatment options at our center. The use of AUC application was easy for identifying the evidence-based treatment options for knee OA. We recommend a prospective study to assess the outcome of AUC application.