Table 1 Guidelines and their indication criteria concerning total hip arthroplasty and total knee arthroplasty
Guideline | Year of publication | OA specific | Evidence | Indication criteria | ||||
|---|---|---|---|---|---|---|---|---|
Pain | Function | Radiological changes | Failed or futile conservative therapy | Other criteria | ||||
Knee | ||||||||
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 | Â | Â |
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. |
Hip | ||||||||
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 | Â | Â |
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 | Â |
Joint | ||||||||
OARSI (hip-knee) [3] | 2008 | Yes | Level IV | No adequate pain relief | No adequate functional improvement | Â | Yes | Â |
NICE [23] | 2014 | Yes | Level IV | Pain | Stiffness and reduced function | Â | Yes | Substantial impact on quality of life |