Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview.
This systematic review gives an overview of guidelines and original publications as well as the evidence on which the currently proposed indication criteria are based. Until now such a state-of-the-science overview was lacking.



Websites of orthopaedic and arthritis organizations (English/Dutch language) were independently searched by two authors for THA/TKA guidelines for OA. Furthermore, a systematic search strategy in several databases through August 2014 was performed. Quality of the guidelines was assessed with the AGREE II instrument, which consists of 6 domains (maximum summed score of 6 indicating high quality). Also, the level of evidence of all included studies was assessed.



We found 6 guidelines and 18 papers, out of 3065 references. The quality of the guidelines summed across 6 domains ranged from 0.46 to 4.78. In total, 12 THA, 10 TKA and 2 THA/TKA indication sets were found. Four studies stated that no evidence-based indication criteria are available. Indication criteria concerning THA/TKA consisted of the following domains: pain (in respectively 11 and 10 sets), function (12 and 7 sets), radiological changes (10 and 9 sets), failed conservative therapy (8 and 4 sets) and other indications (6 and 7 sets). Specific cut-off values or ranges were often not stated and the level of evidence was low.



The indication criteria for THA/TKA are based on limited evidence. Empirical research is needed, especially regarding domain specific cut-off values or ranges at which the best postoperative outcomes are achieved for patients, taking into account the limited lifespan of a prosthesis.
Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands. m.g.j.gademan@lumc.nl.|Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands. m.g.j.gademan@lumc.nl.|Department of Orthopaedics, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. m.g.j.gademan@lumc.nl.|Department of Clinical Epidemiology, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. m.g.j.gademan@lumc.nl.
Maaike G J
MG
Gademan
Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
Stefanie N
SN
Hofstede
Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.|Rijnlands Rehabilitation Center, Leiden, The Netherlands.|Sophia Rehabilitation, The Hague, The Netherlands.
Thea P M
TP
Vliet Vlieland
Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
Rob G H H
RG
Nelissen
Department of Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
Perla J
PJ
Marang-van de Mheen
D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000592:standards*; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000592:standards*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000601:surgery*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome