AAOS Approves Appropriate Use Criteria (AUC) for Non-Arthroplasty Treatment of Osteoarthritis of the Knee

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American Academy of Orthopaedic Surgeons

Dec 17, 2013, 08:00 ET

New AUC offers clinical expertise across medical specialties to help optimize patient care

ROSEMONT, Ill., Dec. 17, 2013 /PRNewswire-USNewswire/ -- The American Academy of Orthopaedic Surgeons (AAOS) Board of Directors recently approved an AUC to help physicians treat patients with osteoarthritis (OA) of the knee. OA is a slowly progressing and degenerative disease that causes the joint cartilage to wear away.

In 2010, it was estimated that nearly 10 million adults had symptomatic OA of the knee, and risk factors of this condition can increase with age, especially in women. Genetics, high body mass, certain occupations or heredity also may increase one's risk of developing this disease. Typically, patients try non-arthroplasty options for many months or years, before considering a total joint replacement surgery.

"The background for this AUC comes from the 2013 AAOS evidence-based clinical practice guideline on OA of the knee, a comprehensive review of all the available evidence," said Michael Heggenness, MD, an orthopaedic surgeon who served as a non-voting moderator during the voting panel process. "This AUC is a tool that takes that guideline one step further; it marries the available evidence with expert medical opinion and is available at the touch of a web and mobile-based app."

"Physicians outside of orthopaedic surgery also can benefit from this tool," Dr. Heggenness added. "Knee pain is so common today and many patients might see their primary care doctor, rheumatologist or other physician for treatment, so we are hoping that other clinicians across medical disciplines familiarize themselves with this AUC and together we can help optimize patient care."

This web-based app (aaos.org/aucapp) is optimized to work on a wide range of devices, including Smartphones and tablets. It allows a clinician to select a variety of patient characteristics and, once submitted, receive appropriateness recommendations for each of the treatments covered by this AUC.

Treatment appropriateness is determined by three separate panels of clinicians who represent a variety of medical disciplines:

The writing panel combined clinical expertise with evidence-based information from the AAOS Evidence Based Clinical Practice Guideline on Treatment of Osteoarthritis of the Knee to create a list of patient indications, assumptions, and treatments.
- Scenarios ranged from a 25-year old patient with post-traumatic OA of the knee who wants to continue playing baseball, to an 80-year old patient who wants to continue walking with his grandchildren to the park.
The review panel provided suggestions regarding improvement of the materials constructed by the writing panel.
The voting panel utilized clinical expertise from multiple medical specialties and evidence-based information to assign the appropriateness of various treatments for each of the patient scenarios, using a 9-point appropriateness scale.

"The panels put tremendous thought into this AUC with careful analysis of appropriate care both through the published literature and extensive clinical experience" said James Sanders, MD, AAOS AUC Section Leader who also served as a non-voting moderator.

The panels came up with 10 different treatment options across 576 patient scenarios. Out of more than 5,700 different patient/treatment combinations:

53 percent were rated as "Appropriate"
29 percent were rated as "May Be Appropriate"
18 percent were rated as "Rarely Appropriate"

"AUC's can provide a useful framework for surgeons and their patients to consider the appropriateness of various treatment options, based on the medical evidence and the opinion and experience of experts," added Kevin Bozic, MD, MBA, chair of the AAOS Council on Research and Quality. "However, in addition to the medical evidence, any treatment decision should also take into consideration the physician's experience and expertise, and the patient's preferences and values."

Additional AUCs covering a variety of orthopaedic conditions, diseases, and diagnostic procedures will soon follow. Rotator cuff treatment and distal radius fracture AUC's already are available. The complete AUC document, along with a list of panel members is available online at www.aaos.org/auc.

Funding for this AUC was provided by AAOS. Development of AUC is overseen by the AUC section of the Evidence-Based Quality and Value Committee and the Council on Research and Quality.

Volunteers from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician's independent medical judgment, given the individual patient's clinical circumstances, should always determine patient care and treatment. Practitioners are advised to consider management options in the context of their own training and background and institutional capabilities

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SOURCE American Academy of Orthopaedic Surgeons