title: Use of explicit criteria for total hip joint replacement fixation techniques.
abstract: We developed a tool to judge the appropriateness of indications and fixation mechanisms for total hip joint replacement (THJR) and applied it to a sample of patients. Criteria were developed using a modified Delphi panel judgment process, following the RAND methodology (RAM). We recruited, during 1 year, patients with a diagnosis of osteoarthritis undergoing THJR in five public hospitals. The appropriateness of the THJR intervention and the fixation mechanism was judged by the explicit criteria developed by a panel of experts. Of the 216 scenarios scored by the panel for the use of each of three fixation mechanisms, the cemented fixation was considered inappropriate in 69.5%, versus just 33.3% for the non cemented. Of those scenarios considered appropriate, the most appropriate mechanism of fixation was considered to be non cemented (74.4%), while cemented (17.8%) and hybrid (7.8%) scenarios were scored as appropriate less often. The previous explicit criteria were applied to 583 real patients. After evaluation of the interventions, 30% of the fixation mechanisms used were considered appropriate, while 21.8% inappropriate. Appropriate use of fixation mechanisms varied among hospitals. RAM can provide explicit criteria to help in clinical decision making and evaluating indications for a THJR intervention. Nevertheless, in the case of the appropriateness of fixation mechanisms, due to the lack of evidence, the panel criteria were biased towards the non cemented technique, which had important implications for the evaluation of some hospitals.
authors.affiliation: Unidad de Investigación, Hospital de Galdakao, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya, Spain. jmquinta@hgda.osakidetza.net
authors.forename: José M
authors.initials: JM
authors.lastname: Quintana
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Aróstegui
authors.forename: Jesús
authors.initials: J
authors.lastname: Azkarate
authors.forename: J Ignacio
authors.initials: JI
authors.lastname: Goenaga
authors.forename: Ramón
authors.initials: R
authors.lastname: Tobio
authors.forename: Jose M
authors.initials: JM
authors.lastname: Aranburu
authors.forename: Begoña
authors.initials: B
authors.lastname: Goikoetxea
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002484:Cementation / Q000592:standards / Q000706:statistics & numerical data*; D003657:Decision Making; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D006615:Hip / Q000473:pathology / Q000601:surgery; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D009984:Orthopedic Fixation Devices / Q000592:standards; D009985:Orthopedics / Q000592:standards*; D010003:Osteoarthritis / Q000601:surgery*; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D013030:Spain; D014600:Utilization Review / Q000379:methods*