Summary

Clinical Parameters Based Criterion (CPC) mathematical system for categorization and prioritization of the patients waiting for Knee Arthroplasty.

Abstract

Introduction

Most commonly a surgical date for knee arthroplasty is based on that particular visit to doctor i.e. “first come first serve basis”. We developed a scoring criterion, which allows surgeons and health care systems to prioritize patients awaiting arthroplasty based on clinical and radiological criterion detecting advanced disease so that patients can have surgery at an early stage before their disease progresses to advance stage. Literature shows advance disease requires special implants, longer operating time and hospital stay, increased post-operative complication and reduced range of motion.

Methods

Value of scoring systems is well established for assessment and auditing in orthopedics. Our scoring system categorizes the Knee Osteoarthritis as Routine and Complex, based upon two scores a) Clinical symptoms score. b) Radiological and examination score. Oxford Knee score for (a) and Lawrence & Kellgren, hip-knee-ankle angle, varus/valgus and FFD, bone loss for (b) + evidenced based conditions like BMI, Osteoporosis, skin, vascular, neurological, hip and spine pathologies get negative points 1-3. To check the accuracy and predictive value of system, we applied the scoring to our existing patients who had surgery and then applied it to our waiting list prioritized group.

Results

:Statistical analysis between Routine and Complex group and prioritized group shows clear advantages of early and prioritized surgery . Pearson’s chi-squared or Fisher’s exact test, analyses were two-tailed and significance p<0.05 it also validates the scoring system. DISCUSSION The scoring system is a useful tool that can accurately identifies the patients who could benefit from early surgery. This gives a robust mathematical tool based on clinical factors to prioritize or alter the waiting lists .This in turn improves surgical outcomes, saves cost of overall health care. Provides a mathematical robust system to change waiting lists.