Measure description
Percentage of patients 18 years of age and older who received an elective primary total knee arthroplasty (TKA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery
Rationale
Total knee arthroplasties (TKAs) are common surgical procedures for addressing knee pain and functional impairment, primarily caused by osteoarthritis. From 2008 to 2010, TKAs were the most common procedure for adults age 45 and older. From 2000 to 2010, physicians performed 5.2 million TKAs, with 693,400 procedures performed in 2010 alone (Williams, Wolford, & Bercovitz, 2015). Although TKAs were introduced as a procedure for older adults, the mean age of patients undergoing TKA is decreasing. In 2010, the mean age for those undergoing TKA was 66.2, a 3.9 percent decrease from 68.9 in 2000. Kurtz et al. (2009) projected that patients younger than 65 would account for 55 percent of TKAs by 2030. This growth in knee surgeries for younger patients is significant because they often require more expensive joint arthroplasties that will better withstand wear caused by physical activity (Bozic et al., 2006).
This measure evaluates whether patients complete a patient-reported functional status assessment (FSA) before and after a TKA. Measuring functional status for patients undergoing total knee replacement permits longitudinal assessment - from the patient's perspective - of the impact of surgical intervention on pain, physical function, as well as health-related quality of life (Rothrock et al., 2010).
Clinical Recommendation Statements
While there is no clinical guideline recommending that clinicians assess patients who are undergoing total knee replacements using patient-reported outcomes of function and pain, several clinical specialty societies support the use of a general health questionnaire and a disease-specific questionnaire for these patients. In particular, they recommend the Veterans RAND 12-item health survey (VR-12) or the Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global as the general health questionnaire and the Knee Injury and Osteoarthritis Outcome Score [KOOS], Jr. as the disease-specific questionnaire (American Association of Orthopaedic Surgeons, the American Joint Replacement Registry, The Hip Society, The Knee Society, & the American Association of Hip and Knee Surgeons, 2015).