title: OARSI/OMERACT initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis. An OMERACT 10 Special Interest Group.
abstract: OBJECTIVE
  To define pain and physical function cutpoints that would, coupled with structural severity, define a surrogate measure of "need for joint replacement surgery," for use as an outcome measure for potential structure-modifying interventions for osteoarthritis (OA).
  
  
  METHODS
  New scores were developed for pain and physical function in knee and hip OA. A cross-sectional international study in 1909 patients was conducted to define data-driven cutpoints corresponding to the orthopedic surgeons' indication for joint replacement. A post hoc analysis of 8 randomized clinical trials (1379 patients) evaluated the prevalence and validity of cutpoints, among patients with symptomatic hip/knee OA.
  
  
  RESULTS
  In the international cross-sectional study, there was substantial overlap in symptom levels between patients with and patients without indication for joint replacement; indeed, it was not possible to determine cutpoints for pain and function defining this indication. The post hoc analysis of trial data showed that the prevalence of cases that combined radiological progression, high level of pain, and high degree of function impairment was low (2%-12%). The most discriminatory cutpoint to define an indication for joint replacement was found to be [pain (0-100) + physical function (0-100) > 80].
  
  
  CONCLUSIONS
  These results do not support a specific level of pain or function that defines an indication for joint replacement. However, a tentative cutpoint for pain and physical function levels is proposed for further evaluation. Potentially, this symptom level, coupled with radiographic progression, could be used to define "nonresponders" to disease-modifying drugs in OA clinical trials.
authors.affiliation: Paris Descartes University, Medicine Faculty, Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Simon
authors.initials: S
authors.lastname: Paternotte
authors.forename: Clifton O
authors.initials: CO
authors.lastname: Bingham
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Clegg
authors.forename: Philippe
authors.initials: P
authors.lastname: Coste
authors.forename: Philip G
authors.initials: PG
authors.lastname: Conaghan
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Giacovelli
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Gunther
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
authors.forename: Marc C
authors.initials: MC
authors.lastname: Hochberg
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Jordan
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.forename: Margreet
authors.initials: M
authors.lastname: Kloppenburg
authors.forename: Arturo
authors.initials: A
authors.lastname: Lanzarotti
authors.forename: Keith
authors.initials: K
authors.lastname: Lim
authors.forename: L Stefan
authors.initials: LS
authors.lastname: Lohmander
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Mahomed
authors.forename: Jean Francis
authors.initials: JF
authors.lastname: Maillefert
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Manno
authors.forename: Lyn M
authors.initials: LM
authors.lastname: March
authors.forename: Steven A
authors.initials: SA
authors.lastname: Mazzuca
authors.forename: Karel
authors.initials: K
authors.lastname: Pavelka
authors.forename: Leonardo
authors.initials: L
authors.lastname: Punzi
authors.forename: Ewa M
authors.initials: EM
authors.lastname: Roos
authors.forename: Lucio C
authors.initials: LC
authors.lastname: Rovati
authors.forename: Helen
authors.initials: H
authors.lastname: Shi
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
authors.forename: Eleonora
authors.initials: E
authors.lastname: Tajana-Messi
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003430:Cross-Sectional Studies; D018450:Disease Progression; D006801:Humans; D007391:International Cooperation; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome