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Table 1 Guidelines and their indication criteria concerning total hip arthroplasty and total knee arthroplasty

From: Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview

Guideline Year of publication OA specific Evidence Indication criteria
Pain Function Radiological changes Failed or futile conservative therapy Other criteria
British Orthopedic Association [24] 2013 Yes Level IV Moderate or severe pain   KL > III in at least one of the knee joints compartments Yes Patients outside these criteria may still be considered for surgery but a second opinion/ recorded case discussion is advised. Cases focus on patients without pain (primary indication) but who present with: functional disability in the presence of end stage cartilage disease. Progressive deformity of the knee (varus/valgus) with functional disability.
Eular [19] 2003 Yes Level IV Refractory pain Disability Radiological evidence of knee OA   
NZ [40] ? No, but based on BOA guidelines which is OA specific Level IV Severe pain Disability Radiological changes Yes Occasionally there may be an indication to replace a knee because of progressive deformity and/or instability, and pain may not necessarily be the most significant factor. Where comorbidities exist risk benefit considerations may rule out the operation in an individual patient.
British Orthopedic Association [41] 2013 No Level IV Inadequately controlled by medication Restriction in function Narrowing of the joint space Yes Compromised quality of life
Eular [20] 2005 Yes Level IV Refractory pain Disability Radiological evidence of hip OA   
NOV [42] 2010 No Level IV Pain Function loss Radiological changes Yes Younger age and obesity are relative contraindications. Delay of surgery in high age is not advisable in view of reduced functional outcome and increased mortality. In addition when progressive loss of function (with or without contractures) predominates over pain, surgery should not be delayed in view of reduced postoperative functional outcome.
NZ [43] ? No Level IV Significant pain Disability Radiological changes Yes  
OARSI (hip-knee) [3] 2008 Yes Level IV No adequate pain relief No adequate functional improvement   Yes  
NICE [23] 2014 Yes Level IV Pain Stiffness and reduced function   Yes Substantial impact on quality of life
  1. Legend to Table 2: KL Kellgren Lawrence, OA osteoarthritis