title: Criteria used when deciding on eligibility for total knee arthroplasty--Between thinking and doing.
abstract: BACKGROUND
  Clinical decision-making in total knee arthroplasty (TKA) is a complex process needing further clarification. The aim of this study was to compare TKA eligibility criteria considered most important by orthopedic surgeons (OSs) to characteristics of patients with knee osteoarthritis (OA) eventually found eligible for TKA.
  
  
  METHODS
  Nine OSs chose the five criteria most important when deciding on TKA eligibility. Cross-sectional data from 200 patients found either eligible (n=100) or not eligible (n=100) for TKA by one of the nine OS, were analyzed in a regression analyses with TKA eligibility as the dependent variable.
  
  
  RESULTS
  Radiographic severity (n=8), pain (n=9), functional disability (n=8) and not responding to the recommended non-surgical treatment (n=7) were considered most important by OSs. Associations (P<0.25) between TKA eligibility and criteria found important by the OS were demonstrated for worse radiographic severity and more functional limitations, but not for pain and not responding to the recommended non-surgical treatment. Furthermore, more comorbidities and higher Body Mass Index (BMI) were associated with TKA-eligibility, but not found important for TKA eligibility by the OS.
  
  
  CONCLUSIONS
  Radiographic severity and functional limitations were confirmed as drivers for TKA eligibility, while pain was not. Not responding to non-surgical treatment was not included in the decision-making, suggesting low uptake of clinical guidelines in clinical practice. This study highlights the complexity of the decision-making with some overlap between the criteria that OSs think they apply and what is actually applied in clinical practice.
authors.affiliation: Orthopaedic Surgery Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark; Clinical Nursing Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark. Electronic address: sots@rn.dk.
authors.forename: Søren T
authors.initials: ST
authors.lastname: Skou
authors.affiliation: Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark. Electronic address: eroos@health.sdu.dk.
authors.forename: Ewa M
authors.initials: EM
authors.lastname: Roos
authors.affiliation: Orthopaedic Surgery Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark. Electronic address: mogens.berg.laursen@rn.dk.
authors.forename: Mogens B
authors.initials: MB
authors.lastname: Laursen
authors.affiliation: Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark. Electronic address: misr@rn.dk.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Rathleff
authors.affiliation: Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark. Electronic address: LAN@hst.aau.dk.
authors.forename: Lars
authors.initials: L
authors.lastname: Arendt-Nielsen
authors.affiliation: Orthopaedic Surgery Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark. Electronic address: ohs@rn.dk.
authors.forename: Ole
authors.initials: O
authors.lastname: Simonsen
authors.affiliation: Orthopaedic Surgery Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark. Electronic address: sten.rasmussen@rn.dk.
authors.forename: Sten
authors.initials: S
authors.lastname: Rasmussen
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000592:standards*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Arthroplasty; Decision-making; Knee; Osteoarthritis; Therapeutics