Closing the Evidence-Practice Gap in Total Knee Replacement

Digital communication tool for knee replacement surgeons to improve the uptake of evidence-based criteria

The evidence-to-practice gap for the surgical management of advanced osteoarthritis (OA) of the knee is costly and potentially harmful.

This project is improving the uptake of evidence-based criteria by implementing and evaluating a novel surgeon feedback intervention for those performing total joint replacement.

Total knee joint replacement (TKR) is the only proven effective surgical procedure for managing advanced knee OA. While TKR has revolutionized the treatment of patients crippled by knee OA there is growing concern related to cost, demand and dissatisfaction that compels a reassessment of how this procedure should be best deployed.

In 2015 57,000 Australians received TKRs, representing an increase of 77% since 2003. However, an estimated 25% of TKRs are performed in inappropriate candidates according to evidence-based criteria and a similar proportion do not report a clinically meaningful response to surgery.

Wide variations in treatment practice exist despite the existence of validated appropriateness criteria for TKR. There is substantial evidence that audit and feedback can effectively improve quality of care and that exposure to decision making aids leads to less varied and more accurate judgments of operative risk among surgeons.

The aim of this study is to address inappropriate practices through innovative approach involving audit/feedback, decision aids to support clinical decision-making and the promotion of effective non-operative treatments.

The NSI Lab is leading the development of the SmartApp that will provide a clinical support tool for surgeons. This NHMRC project is a partnership between academic researchers and St. Vincent’s Health Australia (SVHA), the Australian Orthopaedic Association (AOA), Medibank and MOVE.