Surgical Referrals for Total Hip Arthroplasty in Primary Care: The Usefulness of the AAOS' Appropriate Use Criteria

Abstract

Background It has been proven that primary care physicians (PCPs) have a lack of clarity regarding the indications for total hip arthroplasty (THA), making the process of surgical referral prone to variability and inconsistency. The American Academy of Orthopaedic Surgeons' (AAOS) Appropriate Use Criteria (AAOS-AUC) is an evidence-based decision support tool that assists clinicians to select for whom treatment should be indicated. The present study aims to compare the rate of THA surgical referrals made by PCPs using the AAOS-AUC tool and the rate of referrals resultant after formal physician's education based on the current osteoarthritis treatment standards.

Materials and Methods Using a crossover design, 22 PCPs evaluated 2 rounds of 10 clinical cases each, generating 440 simulated clinical encounters of patients with hip osteoarthritis. In 220 simulated encounters, the PCPs decided if a surgical referral was appropriate by using the AAOS-AUC tool. On the other 220 simulated encounters, that decision was made using the knowledge acquired after formal education. The rate of surgical referrals generated by both strategies was compared.

Results There was no difference in the rate of surgical referrals comparing simulated encounters using the AAOS-AUC tool (57.3%) versus those using clinical judgment after formal education (62.7%; p = 0.2). Neither were there differences when comparing PCPs who used the AAOS-AUC tool during their initial or second round of cases (60.7% versus 58.8% respectively; p = 0.68)

Conclusion In the hands of PCPs, the AAOS-AUC web tool performs as good as formal physician's education in the process of surgical referrals for THA. It is plausible to consider the AAOS-AUC as a practical decision support tool for patients with hip osteoarthritis seen in primary care.

Level of Evidence Level V.

Keywords

total hip arthroplasty - surgical referral - primary care - Appropriate Use Criteria

Publication History

Received: 12 February 2022

Accepted: 28 September 2022

Article published online:
18 May 2023

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