title: The development and validation of a multivariable model to predict whether patients referred for total knee replacement are suitable surgical candidates at the time of initial consultation.
abstract: BACKGROUND
  In previous studies, 50%-70% of patients referred to orthopedic surgeons for total knee replacement (TKR) were not surgical candidates at the time of initial assessment. The purpose of our study was to identify and cross-validate patient self-reported predictors of suitability for TKR and to determine the clinical utility of a predictive model to guide the timing and appropriateness of referral to a surgeon.
  
  
  METHODS
  We assessed pre-consultation patient data as well as the surgeon's findings and post-consultation recommendations. We used multivariate logistic regression to detect self-reported items that could identify suitable surgical candidates.
  
  
  RESULTS
  Patients' willingness to undergo surgery, higher rating of pain, greater physical function, previous intra-articular injections and patient age were the factors predictive of patients being offered and electing to undergo TKR.
  
  
  CONCLUSIONS
  The application of the model developed in our study would effectively reduce the proportion of nonsurgical referrals by 25%, while identifying the vast majority of surgical candidates (> 90%). Using patient-reported information, we can correctly predict the outcome of specialist consultation for TKR in 70% of cases. To reduce long waits for first consultation with a surgeon, it may be possible to use these items to educate and guide referring clinicians and patients to understand when specialist consultation is the next step in managing the patient with severe osteoarthritis of the knee.
authors.affiliation: From the Research Department, Western University, London, Ont., (Churchill, Malian); the Department of Epidemiology and Biostatistics, School of Health Studies, Western University, London, Ont., (Chesworth); the Schulich School of Medicine & Dentistry, Department of Orthopaedic Surgery, Western University, London, Ont., (Bryant, MacDonald, Giffin); and the School of Health Studies, Faculty of Health Sciences, Bone and Joint Institute, Western University, London, Ont., (Marsh).
authors.forename: Laura
authors.initials: L
authors.lastname: Churchill
authors.affiliation: From the Research Department, Western University, London, Ont., (Churchill, Malian); the Department of Epidemiology and Biostatistics, School of Health Studies, Western University, London, Ont., (Chesworth); the Schulich School of Medicine & Dentistry, Department of Orthopaedic Surgery, Western University, London, Ont., (Bryant, MacDonald, Giffin); and the School of Health Studies, Faculty of Health Sciences, Bone and Joint Institute, Western University, London, Ont., (Marsh).
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Malian
authors.affiliation: From the Research Department, Western University, London, Ont., (Churchill, Malian); the Department of Epidemiology and Biostatistics, School of Health Studies, Western University, London, Ont., (Chesworth); the Schulich School of Medicine & Dentistry, Department of Orthopaedic Surgery, Western University, London, Ont., (Bryant, MacDonald, Giffin); and the School of Health Studies, Faculty of Health Sciences, Bone and Joint Institute, Western University, London, Ont., (Marsh).
authors.forename: Bert M
authors.initials: BM
authors.lastname: Chesworth
authors.affiliation: From the Research Department, Western University, London, Ont., (Churchill, Malian); the Department of Epidemiology and Biostatistics, School of Health Studies, Western University, London, Ont., (Chesworth); the Schulich School of Medicine & Dentistry, Department of Orthopaedic Surgery, Western University, London, Ont., (Bryant, MacDonald, Giffin); and the School of Health Studies, Faculty of Health Sciences, Bone and Joint Institute, Western University, London, Ont., (Marsh).
authors.forename: Dianne
authors.initials: D
authors.lastname: Bryant
authors.affiliation: From the Research Department, Western University, London, Ont., (Churchill, Malian); the Department of Epidemiology and Biostatistics, School of Health Studies, Western University, London, Ont., (Chesworth); the Schulich School of Medicine & Dentistry, Department of Orthopaedic Surgery, Western University, London, Ont., (Bryant, MacDonald, Giffin); and the School of Health Studies, Faculty of Health Sciences, Bone and Joint Institute, Western University, London, Ont., (Marsh).
authors.forename: Steven J
authors.initials: SJ
authors.lastname: MacDonald
authors.affiliation: From the Research Department, Western University, London, Ont., (Churchill, Malian); the Department of Epidemiology and Biostatistics, School of Health Studies, Western University, London, Ont., (Chesworth); the Schulich School of Medicine & Dentistry, Department of Orthopaedic Surgery, Western University, London, Ont., (Bryant, MacDonald, Giffin); and the School of Health Studies, Faculty of Health Sciences, Bone and Joint Institute, Western University, London, Ont., (Marsh).
authors.forename: Jacquelyn D
authors.initials: JD
authors.lastname: Marsh
authors.affiliation: From the Research Department, Western University, London, Ont., (Churchill, Malian); the Department of Epidemiology and Biostatistics, School of Health Studies, Western University, London, Ont., (Chesworth); the Schulich School of Medicine & Dentistry, Department of Orthopaedic Surgery, Western University, London, Ont., (Bryant, MacDonald, Giffin); and the School of Health Studies, Faculty of Health Sciences, Bone and Joint Institute, Western University, London, Ont., (Marsh).
authors.forename: J Robert
authors.initials: JR
authors.lastname: Giffin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010003:Osteoarthritis / Q000453:epidemiology* / Q000601:surgery; D011379:Prognosis; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*