{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T23:34:39Z","timestamp":1781048079191,"version":"3.54.1"},"reference-count":0,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background and Objectives Knee osteoarthritis (OA) is a significant public health burden. Rates of total knee arthroplasty (TKA) in OA vary substantially between geographical regions, most likely due to the lack of standardised indication criteria. We set out to define indication criteria for the German healthcare system for TKA in patients with knee OA, on the basis of best evidence and transparent multi-stakeholder consensus.<\/jats:p><jats:p>\n          Methods We undertook a complex mixed methods study, including an iterative process of systematic appraisal of existing evidence, Delphi consensus methods and stakeholder conferences. We established a consensus panel representing key German national societies of healthcare providers (orthopaedic surgeons, rheumatologists, pain physicians, psychologists, physiotherapists), payers, and patient representatives. A priori defined consensus criteria were at least 70% agreement and less than 20% disagreement among the consensus panel. Agreement was sought for (1) core indication criteria defined as criteria that must be met to consider TKA in a normal patient with knee OA, (2) additional (not obligatory) indication criteria, (3) absolute contraindication criteria that generally prohibit TKA, and (4) risk factors that do not prohibit TKA, but usually do not lead to a recommendation for TKA.<\/jats:p><jats:p>\n          Results The following 5 core indication criteria were agreed within the panel: 1. intermittent (several times per week) or constant knee pain for at least 3\u200a\u2013\u200a6 months; 2. radiological confirmation of structural knee damage (osteoarthritis, osteonecrosis); 3. inadequate response to conservative treatment, including pharmacological and non-pharmacological treatment for at least 3\u200a\u2013\u200a6 months; 4. adverse impact of knee disease on patient\u02bcs quality of life for at least 3\u200a\u2013\u200a6 months; 5. patient-reported suffering\/impairment due to knee disease. Additional indication criteria, contraindication criteria, and risk factors for adverse outcome were also agreed by a large majority within the multi-perspective stakeholder panel.<\/jats:p><jats:p>\n          Conclusion The defined indication criteria constitute a prerequisite for appropriate provision of TKA in patients with knee OA in Germany. In eligible patients, shared-decision making should eventually determine if TKA is performed or not. The next important steps are the implementation of the defined indication criteria, and the prospective investigation of predictors of success or failure of TKA in the context of routine care provision in Germany.<\/jats:p>","DOI":"10.1055\/s-0043-115120","type":"journal-article","created":{"date-parts":[[2017,10,19]],"date-time":"2017-10-19T18:47:18Z","timestamp":1508438838000},"page":"539-548","source":"Crossref","is-referenced-by-count":50,"title":["Indication Criteria for Total Knee Arthroplasty in Patients with Osteoarthritis \u2013 A Multi-perspective Consensus Study"],"prefix":"10.1055","volume":"155","author":[{"given":"Jochen","family":"Schmitt","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Evidenzbasierte Gesundheitsversorgung, Universit\u00e4tsklinikum und Medizinische Fakult\u00e4t Carl Gustav Carus, TU Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toni","family":"Lange","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Evidenzbasierte Gesundheitsversorgung, Universit\u00e4tsklinikum und Medizinische Fakult\u00e4t Carl Gustav Carus, TU Dresden"},{"name":"Universit\u00e4tsCentrum f\u00fcr Orthop\u00e4die und Unfallchirurgie, Universit\u00e4tsklinikum Carl Gustav Carus, TU Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus-Peter","family":"G\u00fcnther","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsCentrum f\u00fcr Orthop\u00e4die und Unfallchirurgie, Universit\u00e4tsklinikum Carl Gustav Carus, TU Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kopkow","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Evidenzbasierte Gesundheitsversorgung, Universit\u00e4tsklinikum und Medizinische Fakult\u00e4t Carl Gustav Carus, TU Dresden"},{"name":"Department f\u00fcr Angewandte Gesundheitswissenschaften, Hochschule f\u00fcr Gesundheit, Bochum"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Rataj","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Evidenzbasierte Gesundheitsversorgung, Universit\u00e4tsklinikum und Medizinische Fakult\u00e4t Carl Gustav Carus, TU Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Apfelbacher","sequence":"additional","affiliation":[{"name":"Medizinische Soziologie, Institut f\u00fcr Epidemiologie und Pr\u00e4ventivmedizin, Universit\u00e4tsklinik Regensburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Aringer","sequence":"additional","affiliation":[{"name":"Deutsche Gesellschaft f\u00fcr Rheumatologie e.\u200aV. (DGRh)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eckhardt","family":"B\u00f6hle","sequence":"additional","affiliation":[{"name":"Deutscher Verband f\u00fcr Physiotherapie e.\u200aV. (ZVK)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartmut","family":"Bork","sequence":"additional","affiliation":[{"name":"Sektion Rehabilitation \u2013 Physikalische Therapie (DGOU)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsten","family":"Dreinh\u00f6fer","sequence":"additional","affiliation":[{"name":"Orthop\u00e4die Berlin Humboldtm\u00fchle, Medical Park"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklaus","family":"Friederich","sequence":"additional","affiliation":[{"name":"Deutsche Arthrose-Hilfe e.\u200aV."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Heinz","family":"Frosch","sequence":"additional","affiliation":[{"name":"Deutsche Gesellschaft f\u00fcr Unfallchirurgie e.\u200aV. (DGU)"},{"name":"Deutsche Kniegesellschaft e.\u200aV. (DKG)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Gravius","sequence":"additional","affiliation":[{"name":"Deutsche Gesellschaft f\u00fcr Orthop\u00e4die und orthop\u00e4dische Chirurgie e.\u200aV. (DGOOC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Gromnica-Ihle","sequence":"additional","affiliation":[{"name":"Deutsche Rheuma-Liga Bundesverband e.\u200aV."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Dieter","family":"Heller","sequence":"additional","affiliation":[{"name":"AE \u2013 Deutsche Gesellschaft f\u00fcr Endoprothetik e.\u200aV."},{"name":"Berufsverband f\u00fcr Orthop\u00e4die und Unfallchirurgie e.\u200aV. (BVOU)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Kirschner","sequence":"additional","affiliation":[{"name":"AE \u2013 Deutsche Gesellschaft f\u00fcr Endoprothetik e.\u200aV."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Kladny","sequence":"additional","affiliation":[{"name":"Deutsche Gesellschaft f\u00fcr Orthop\u00e4die und Unfallchirurgie e.\u200aV. (DGOU)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Kohlhof","sequence":"additional","affiliation":[{"name":"Deutsche Gesellschaft f\u00fcr Orthop\u00e4die und orthop\u00e4dische Chirurgie e.\u200aV. (DGOOC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kremer","sequence":"additional","affiliation":[{"name":"Deutsche Gesellschaft f\u00fcr Unfallchirurgie e.\u200aV. 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(DGOOC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Wagner","sequence":"additional","affiliation":[{"name":"Deutsche Gesellschaft f\u00fcr Orthop\u00e4dische Rheumatologie e.\u200aV. (DGORh)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"L\u00fctzner","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsCentrum f\u00fcr Orthop\u00e4die und Unfallchirurgie, Universit\u00e4tsklinikum Carl Gustav Carus, TU Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2017,10,19]]},"container-title":["Zeitschrift f\u00fcr Orthop\u00e4die und Unfallchirurgie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-115120.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2017,12,19]],"date-time":"2017-12-19T08:27:53Z","timestamp":1513672073000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-115120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10]]},"references-count":0,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2017,10,19]]},"published-print":{"date-parts":[[2017,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-115120","relation":{},"ISSN":["1864-6697","1864-6743"],"issn-type":[{"value":"1864-6697","type":"print"},{"value":"1864-6743","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10]]}}}