appropriate use criteria for the surgical ......kevin shea, md chair, aaos council on research and...
TRANSCRIPT
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APPROPRIATE USE CRITERIA
FOR THE SURGICAL MANAGEMENT OF
OSTEOARTHRITIS OF THE KNEE
Adopted by the American Academy of Orthopaedic Surgeons
Board of Directors
12/09/2016
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Disclaimer
Volunteer physicians from multiple medical specialties created and categorized these
Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive
or a fixed protocol, as some patients may require more or less treatment or different means of
diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians
treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s
independent medical judgment, given the individual patient’s clinical circumstances, should
always determine patient care and treatment.
Disclosure Requirement
In accordance with American Academy of Orthopaedic Surgeons policy, all individuals whose
names appear as authors or contributors to this document filed a disclosure statement as part of
the submission process. All authors provided full disclosure of potential conflicts of interest prior
to participation in the development of these Appropriate Use Criteria. Disclosure information for
all panel members can be found in Appendix B.
Funding Source
The American Academy of Orthopaedic Surgeons exclusively funded development of these
Appropriate Use Criteria. The American Academy of Orthopaedic Surgeons received no funding
from outside commercial sources to support the development of these Appropriate Use Criteria.
FDA Clearance
Some drugs or medical devices referenced or described in this document may not have been
cleared by the Food and Drug Administration (FDA) or may have been cleared for a specific use
only. The FDA has stated that it is the responsibility of the physician to determine the FDA
clearance status of each drug or device he or she wishes to use in clinical practice.
Copyright
All rights reserved. Reproduction, storage in a retrieval system, or transmission, in any form, or
by any means, electronic, mechanical, photocopying, recording, or otherwise, of any part of this
document, requires prior written permission from the American Academy of Orthopaedic
Surgeons.
Published 2016 by the American Academy of Orthopaedic Surgeons
9400 West Higgins Road
Rosemont, IL 60018
First Edition
Copyright 2016 by the American Academy of Orthopaedic Surgeons
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For a more user-friendly version of this AUC, or to view additional
AUCs, please visit the AAOS AUC web-based app at:
www.OrthoGuidelines.org/auc
To view the clinical practice guideline for this topic, please visit
www.orthoguidelines.org/smoakguideline
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Table of Contents
Writing Panel .............................................................................................................................. ii
Voting Panel................................................................................................................................ ii Voting Panel Round Two Discussion Moderator ...................................................................... iii AUC Section Leader, AAOS Committee on Evidence-Based Quality and Value .................... iii Chair, AAOS Committee on Evidence-Based Quality and Value ............................................. iii Chair, AAOS Council on Research and Quality ........................................................................ iii
AAOS Staff ................................................................................................................................ iii
I. INTRODUCTION ...................................................................................................................1
Overview ..................................................................................................................................... 1 Assumptions of the Writing Panel/Voting Panel ........................................................................ 2 Patient Population ....................................................................................................................... 2
Burden of Disease ....................................................................................................................... 3 Etiology ....................................................................................................................................... 3
Incidence and Prevalence ............................................................................................................ 3
Potential Benefits, Harms, and Contraindications ...................................................................... 3
II. METHODS ..............................................................................................................................4
Developing Criteria ..................................................................................................................... 5
Formulating Indications and Scenarios ................................................................................... 5 Creating Definitions and Assumptions ................................................................................... 6
Literature Review........................................................................................................................ 7 Determining Appropriateness ..................................................................................................... 8
Voting Panel............................................................................................................................ 8
Rating Appropriateness ........................................................................................................... 8
Round One Voting .................................................................................................................. 9
Rounds Two and three Voting .............................................................................................. 10 Final Ratings ......................................................................................................................... 10
Revision Plans ........................................................................................................................... 11 Disseminating Appropriate Use Criteria ................................................................................... 12
III. PATIENT INDICATIONS AND TREATMENTS ...............................................................13
Indications ................................................................................................................................. 13 Treatments................................................................................................................................. 14
IV. RESULTS OF APPROPRIATENESS RATINGS ................................................................15
Appropriate Use Criteria for The Surgical Management of Osteoarthritis of the Knee ........... 20
V. APPENDICES .....................................................................................................................309
Appendix A. Documentation of Approval .............................................................................. 310 Appendix B. Disclosure Information ...................................................................................... 311
SMOAK AUC Writing Panel ............................................................................................. 311 SMOAK AUC Voting Panel ............................................................................................... 312
Appendix C. References ......................................................................................................... 314
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Writing Panel
1. Paul A Manner, MD
American Academy of Orthopaedic
Surgeons
2. Bryan Bomberg, MD
American Academy of Orthopaedic
Surgeons
3. Samuel Hawken, MD
American Academy of Orthopaedic
Surgeons
4. Tamara N Huff, MD
Ruth Jackson Orthopaedic Society
5. Charles L Nelson, MD
J. Robert Gladden Society
6. David T Neuman, MD
American Academy of Orthopaedic
Surgeons
7. Frederick F Buechel, Jr, MD
American Academy of Orthopaedic
Surgeons
8. Brett R Levine, MD
American Academy of Orthopaedic
Surgeons
9. Chick Yates Jr, MD
American Association of Hip and Knee
Surgeons
10. Louis F. McIntyre, MD
Arthroscopy Association of North America
Voting Panel
1. Dennis C. Chin, MD
American Academy of Orthopaedic
Surgeons
2. Marc M. DeHart, MD
American Academy of Orthopaedic
Surgeons
3. John R. Martell, Jr., MD
American Academy of Orthopaedic
Surgeons
4. Kim J. Chillag, MD
American Academy of Orthopaedic
Surgeons
5. Steven A. Silver, MD
American Academy of Orthopaedic
Surgeons
6. Brad Bushnell, MD
Arthroscopy Association of North America
7. Claudette Lajam, MD *
Ruth Jackson Orthopaedic Society
8. Gwo-Chin Lee, MD
The Knee Society
9. Morgan H. Jones, MD *
American Orthopaedic Society for Sports
Medicine
10. Neil Segal, MD, MS
American Academy of Physical Medicine
and Rehabilitation
11. Creighton Collins Tubb, MD
Society of Military Orthopaedic Surgeons
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iii
Voting Panel Round Two Discussion Moderator
Robert H. Quinn, MD
AUC Section Leader, AAOS Committee on Evidence-Based Quality and Value
Robert H. Quinn, MD
Chair, AAOS Committee on Evidence-Based Quality and Value
Kevin Shea, MD
Chair, AAOS Council on Research and Quality
David Jevsevar, MD, MBA
AAOS Staff
William O. Shaffer, MD
Medical Director
Deborah S. Cummins, PhD
Director, Department of Research and Scientific Affairs
Jayson Murray, MA
Manager, Evidence-Based Medicine Unit
Ryan Pezold, MA
Lead Research Analyst, Evidence-Based Medicine Unit
Peter Shores, MPH
Statistician, Evidence-Based Medicine
Anne Woznica, MLS
Medical Librarian
Kaitlyn Sevarino, MBA
Evidence-Based Quality and Value (EBQV) Specialist
Erica Linskey
Administrative Assistant, Evidence-Based Medicine Unit
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1 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
I. INTRODUCTION
OVERVIEW
The American Academy of Orthopaedic Surgeons (AAOS) has developed this Appropriate Use
Criteria (AUC) to determine appropriateness of various health care services for the Surgical
Management of Osteoarthritis of the Knee. The scope of these appropriate use criteria includes
nonpharmacologic and pharmacologic interventions for symptomatic osteoarthritis of the knee as
well as operative procedures. It does not provide recommendations for patients diagnosed with
rheumatoid arthritis, osteoarthritis of other joints, or other inflammatory arthropathies.
An “appropriate” healthcare service is one for which the expected health benefits exceed the
expected negative consequences by a sufficiently wide margin.2 Evidence-based information, in
conjunction with the clinical expertise of physicians from multiple medical specialties, was used
to develop the criteria in order to improve patient care and obtain the best outcomes while
considering the subtleties and distinctions necessary in making clinical decisions. To provide the
evidence foundation for this AUC, the AAOS Evidence-Based Medicine Unit provided the
writing panel and voting panel with the 2015 AAOS Clinical Practice Guideline on the Surgical
Management of Osteoarthritis of the Knee, which can be accessed via the following link:
www.orthoguidelines.org/smoakguideline.
The purpose of this AUC is to help determine the appropriateness of clinical practice guideline
recommendations for the heterogeneous patient population routinely seen in practice. The best
available scientific evidence is synthesized with collective expert opinion on topics where gold
standard randomized clinical trials are not available or are inadequately detailed for identifying
distinct patient types. When there is evidence corroborated by consensus that expected benefits
substantially outweigh potential risks, exclusive of cost, a procedure is determined to be
appropriate. The AAOS uses the RAND/UCLA Appropriateness Method (RAM).2 Our process
includes these steps: reviewing the results of the evidence analysis, compiling a list of clinical
vignettes, and having an expert panel comprised of representatives from multiple medical
specialties to determine the appropriateness of each of the clinical indications for treatment as
“Appropriate,” “May be Appropriate,” or “Rarely Appropriate.” To access an intuitive and more
user-friendly version of the appropriate use criteria for this topic online, please visit our AUC
web-based application at www.orthoguidelines.org/auc or download the OrthoGuidelines app
from Google Play or Apple Store.
These criteria should not be construed as including all indications or excluding indications
reasonably directed to obtaining the same results. The criteria intend to address the most
common clinical scenarios facing all appropriately trained surgeons and all qualified physicians
managing patients under consideration for surgically treating osteoarthritis of the knee. The
ultimate judgment regarding any specific criteria should address all circumstances presented by
the patient and the needs and resources particular to the locality or institution. It is also important
to state that these criteria were developed as guidelines and are not meant to supersede clinician
expertise and experience or patient preference.
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2 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
INTERPRETING THE APPROPRIATENESS RATINGS
To prevent misuse of these criteria, it is extremely important that the user of this document
understands how to interpret the appropriateness ratings. The appropriateness rating scale ranges
from one to nine and there are three main range categories that determine how the median rating
is defined (i.e. 1-3 = “Rarely Appropriate”, 4-6 = “May Be Appropriate”, and 7-9 =
“Appropriate”). Before these appropriate use criteria are consulted, the user should read through
and understand all contents of this document.
ASSUMPTIONS OF THE WRITING PANEL/VOTING PANEL
Before these appropriate use criteria are consulted, it is assumed that:
1. The clinician knows the contraindication to the utilization of certain medications and the
anesthetic or important surgical contraindications to operative interventions.
2. The patient has a diagnosis of osteoarthritis of the knee. This AUC does not address
inflammatory arthritis.
3. The patient is symptomatic including pain, instability, stiffness, and/or deformity that
leads to loss of function.
4. The patient’s symptoms are consistent with the history, physical exam, and imaging
findings.
5. The imaging findings are consistent with osteoarthritis which may include: joint space
narrowing, sclerosis, presence of cysts, and/or osteophytes.
6. Patient has failed other relevant appropriate treatments.
7. AP and/or PA-flexion weight-bearing, lateral, and patellar view radiographs are
recommended when possible.
8. The physical examination, history, and imaging studies have excluded the following as
the main cause of knee pain:
o Referred pain from the spine
o Ipsilateral hip arthritis
o Ankle/foot deformity
o Vascular disease (arterial or venous)
o Non-articular causes of knee pain including soft-tissue disorders
o Neoplasm
o Neuropathy
o Stress fractures, insufficiency fracture, osteonecrosis, or symptomatic metabolic
bone disease
9. Shared decision making is encouraged between the patient and surgeon with an emphasis
on realistic expectations.
10. There will be patients not considered in this AUC (e.g. inflammatory arthritis) for whom
arthroplasty may be the most appropriate treatment, but the appropriateness of
arthroplasty for these patients was not considered in these appropriate use criteria.
PATIENT POPULATION
This AUC is intended for use with adults who have been diagnosed by a physician with
osteoarthritis of the knee and are undergoing treatment.
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3 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
BURDEN OF DISEASE The burden of osteoarthritis (OA) of the knee is largely attributable to the effects of disability,
comorbid disease, and the expense of treatment. OA is the most frequent cause of disability
among adults in the United States (US), and the burden is increasing both as the prevalence of
OA increases and also as patient expectations for treatment rise. Twenty seven million adults
(more than 10 percent) of the US adult population had clinical osteoarthritis (OA) in 2005, and in
2009 OA was the fourth most common cause of hospitalization (Murphy & Helmick, 2012).
OA is the leading indication for joint replacement surgery; 905,000 knee and hip replacements
were performed in 2009 at a cost of 42.3 billion dollars (Murphy & Helmick, 2012).
Costs to be considered include:
1. Direct Medical Cost
2. Long-term Medical Cost
3. Home Modification Costs
4. Nursing Home Costs
ETIOLOGY Patients who require surgical treatment for osteoarthritis of the knee have developed the
condition naturally over time due to a variety of risk factors or in an accelerated fashion due to
prior trauma about the knee. Osteoarthritis is the imbalance of breakdown and repair of tissues
within a synovial joint. The etiology of osteoarthritis is varied and includes genetic factors,
trauma, prior meniscectomy, overuse, and infection.
INCIDENCE AND PREVALENCE Twenty seven million adults (more than 10 percent) of the US adult population had clinical
osteoarthritis (OA) in 2005, and in 2009 OA was the fourth most common cause of
hospitalization (Murphy & Helmick, 2012). The incidence of knee osteoarthritis is estimated to
affect 240 persons per 100,000/year. It is estimated that 9.9 million adults had symptomatic
osteoarthritis of the knee in 2010.
With rising life expectancy, it is estimated that the prevalence of knee osteoarthritis will continue
to increase. The number of people older than age 65 years is expected to increase from 37.1
million to 77.2 million by the year 2040.
POTENTIAL BENEFITS, HARMS, AND CONTRAINDICATIONS The benefits of surgical treatment of osteoarthritis of the knee include relief of pain and
improved function. Most invasive operative treatments, primarily arthroplasty, are associated
with known risks.
Early postoperative complications include prosthetic infection, venous thromboembolic disease,
arthrofibrosis, and pain. Late postoperative complications include infection, prosthetic aseptic
loosening, and pain. All can lead to a need for revision arthroplasty.
Contraindications are relative and require an in depth discussion with the patient and physician
(surgeon, anesthesiologist) about their individual risk factors. Additional factors, such as the
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4 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
individual’s co-morbidities, and/or specific patient characteristics may affect the physician’s
choice of treatment. Clinician input based on experience increases the probability of identifying
patients who will benefit from specific treatment options. The individual patient and/or their
decision surrogate dynamic will also influence treatment decisions, therefore, discussion of
available treatments and procedures applicable to the individual patient rely on mutual
communication between the patient and/or decision surrogate and physician, weighing the
potential risks and benefits for that patient. Once the patient and/or their decision surrogate have
been informed of available therapies and have discussed these options with the patient’s
physician, an informed decision can be made.
II. METHODS
This AUC for the Surgical Management of Osteoarthritis of the Knee, hereafter referred to as
SMOAK AUC, is based on a review of the available literature and a list of clinical scenarios (i.e.
criteria) constructed and voted on by experts in orthopaedic surgery and other relevant medical
fields. This section describes the methods adapted from the RAND/UCLA Appropriateness
Method (RAM)2. This section also includes the activities and compositions of the various panels
that developed, defined, reviewed, and voted on the criteria.
Two panels participated in the development of the SMOAK AUC (see list on page ii). Members
of the writing panel developed a list of 864 patient scenarios, for which three treatments were
evaluated for appropriateness. The voting panel participated in three rounds of voting. During the
first round of voting, the voting panel was given approximately two months to independently rate
the appropriateness of each the provided treatments for each of the relevant patient scenarios as
‘Appropriate’, ‘May Be Appropriate’, or ‘Rarely Appropriate’ via an electronic ballot. After the
first round of appropriateness ratings were submitted, AAOS staff calculated the median ratings
for each patient scenario and specific treatment. An in-person voting panel meeting was held in
Rosemont, IL on Friday, August 5th of 2016. During this meeting voting panel members
addressed the scenarios/treatments which resulted in disagreement (definition of disagreement
can be found in Table 3). The voting panel members discussed the list of assumptions, patient
indications, and treatments to identify areas that needed to be clarified/edited. After the
discussion and subsequent changes, the group was asked to rerate their first round ratings during
the voting panel meeting, only if they were persuaded to do so by the discussion and available
evidence. After completion of the second round of voting, the voting panel opted to look again
at scenarios which still contained disagreement and open the ballot for a third round of voting.
The voting panel determined appropriateness by rating treatments for the various patient
scenarios (i.e. criteria) as ‘Appropriate’, ‘May Be Appropriate’, or ‘Rarely Appropriate’. There
was no attempt to obtain consensus about appropriateness.
AAOS Appropriate Use Criteria Section, the AAOS Council on Research and Quality, and the
AAOS Board of Directors sequentially approved the SMOAK AUC. AAOS submits this AUC to
the National Guidelines Clearinghouse and, in accordance with the National Guidelines
Clearinghouse criteria, will update or retire this AUC within five years of the publication date.
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5 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
DEVELOPING CRITERIA Panel members of the SMOAK AUC, who are orthopaedic specialists in treating knee-related
injuries/diseases, developed clinical scenarios using the following guiding principles:
• Patient scenarios must include a broad spectrum of patients that may be eligible
for treatment of osteoarthritis of the knee [comprehensive]
• Patient indications must classify patients into a unique scenario [mutually
exclusive]
• Patient indications must consistently classify similar patients into the same
scenario [reliable, valid indicators]
The writing panel developed the scenarios by categorizing patients in terms of indications
evident during the clinical decision making process (Figure 1). These scenarios relied upon
definitions and general assumptions, mutually agreed upon by the writing panel during the
development of the scenarios. These definitions and assumptions were necessary to provide
consistency in the interpretation of the clinical scenarios among experts voting on the scenarios
and readers using the final criteria.
FORMULATING INDICATIONS AND SCENARIOS
The AUC writing panel began the development of the scenarios by identifying clinical
indications typical of patients commonly presenting with osteoarthritis of the knee in clinical
practice. Indications are most often parameters observable by the clinician, including symptoms
or results of diagnostic tests. Additionally, “human factor” (e.g. activity level) or demographic
variables can be considered.
Indication:
Observable/appreciable patient
parameter
Classification:
Class/category of an indication;
standardized by definitions*
Clinical Scenario:
Combination of a single
classification from each indication;
assumptions assist interpretation*
Chapter:
Group of scenarios based on
the major clinical indication
Major clinical indication
Figure 1. Developing Criteria
Criteria:
A unique clinical scenario with
a final appropriateness rating
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6 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
Indications identified in clinical trials (derived from patient selection criteria) included in AAOS
Clinical Practice Guidelines (www.orthoguidelines.org/smoakguideline) served as a starting
point for the writing panel and ensured that these Appropriate Use Criteria referred to the
evidence base for the Surgical Management of Osteoarthritis of the Knee CPG. The writing
panel considered this initial list and other indications based on their clinical expertise and
selected the most clinically relevant indications (Table 4). The writing panel then defined distinct
classes for each indication in order to stratify/categorize the indication (Table 4).
The writing panel organized these indications into a matrix of clinical scenarios that addressed
all combinations of the classifications. The writing panel was given the opportunity to remove
any scenarios that rarely occur in clinical practice, but agreed that all scenarios were clinically
relevant. The major clinical decision making indications chosen by the writing panel divided the
matrix of clinical scenarios into chapters, as follows: function-limiting pain, range of motion
extension/flexion, functional instability, pattern of arthritic involvement (medial tibiofemoral,
lateral tibiofemoral or patellofemoral), imaging (joint space in most involved compartment),
limb alignment, mechanical symptoms (compatible with meniscal tear or loose body), and age.
CREATING DEFINITIONS AND ASSUMPTIONS
The SMOAK AUC writing panel constructed concise and explicit definitions for the indications
and classifications. This standardization helped ensure the way that the writing panel defined the
patient indications was consistent among those reading the clinical scenario matrix or the final
criteria. Definitions drew explicit boundaries when possible and were based on standard medical
practice or existing literature.
Additionally, the writing panel formulated a list of general assumptions in order to provide more
consistent interpretations of a scenario (see Assumptions of the Writing Panel). These
assumptions differed from definitions in that they identified circumstances that exist outside of
the control of the clinical decision making process.
Assumptions also addressed the use of existing published literature regarding the effectiveness of
treatment and/or the procedural skill level of physicians. Additionally, assumptions highlighted
intrinsic methods described in this document such as the role of cost considerations in rating
appropriateness or the validity of the definition of appropriateness. The main goal of assumptions
was to focus scenarios so that they apply to the average patient presenting to an average
physician at an average facility.1
The definitions and assumptions should provide all readers with a common starting point in
interpreting the clinical scenarios. This list of definitions and assumptions accompanied the
matrix of clinical scenarios in all stages of the development of this AUC and appears in the
Assumptions of the Writing Panel section of this document.
VOTING PANEL MODIFICATIONS TO WRITING PANEL MATERIALS
At the start of the in-person voting panel meeting, the voting panel was reminded that they have
the ability to amend the original writing panel materials if the amendments resulted in more
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7 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
clinically relevant and practical criteria. In order to amend the original materials, the voting panel
members were instructed that a member must make a motion to amend and another member
must “second” that motion, after which a vote is conducted. If a majority of voting panel
members voted “yes” to amend the original materials, the amendments were accepted.
The voting panel opted to make the following amendment/addition to the original AUC
materials:
1. Change “Unicompartmental knee arthroplasty” to Unicompartmental knee arthroplasty
(medial or lateral tibiofemoral joint, not patellofemoral)
1. Change “Realignment Osteotomy (distal femoral and/or tibial osteotomy)” to
“Realignment Osteotomy (varus or valgus producing femoral or tibial osteotomy)”
2. Add the following language to the Assumptions list: “Patient has failed other relevant
appropriate treatments.”
3. Modify “Imaging” patient category to remove “without complete loss of joint space”
from “Mild to Moderate” patient subcategory and remove “complete loss of joint space”
from “Severe” patient subcategory.
4. Change “Ligamentous Instability” patient indication to “Functional instability”
LITERATURE REVIEW The 2015 Clinical Practice Guideline on the Surgical Management of Osteoarthritis of the Knee
was used as the evidence base for this AUC (www.orthoguidelines.org/smoakguideline). This
guideline helped to inform the decisions of the writing panel and voting panel where available
and necessary.
Direct links to the evidence for the treatments discussed in this AUC can be found below:
• Total knee arthroplasty
o Peripheral Nerve Blockade (PNB)
o Preoperative Physical Therapy
o Peri-Articular Local Anesthetic Infiltration
o Tourniquet: Blood Loss Reduction
o Tourniquet: Postoperative Pain Reduction
o Neuraxial Anesthesia
o Tourniquet: Postoperative Function
o Tranexamic Acid
o Antibiotic Bone Cement
o Polyethylene Tibial Components
o Patellar Resurfacing: Pain and Function
o Surgical Navigation
o Patient Specific Instrumentation: Pain and Function
o Patient Specific Instrumentation: Transfusions and Complications
o Drains
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8 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
o Postoperative Mobilization: Length of Stay
o Postoperative Mobilization: Pain and Function
o Bone Cement: Cemented Tibial Components VERSUS Cementless Tibial
Components
o Bone Cement: Cemented Femoral & Tibial Components Versus Cementless
Femoral & Tibial Components
o Bone Cement: All Cemented Components versus Hybrid Fixation (Cementless
Femoral Component)
o Bone Cement: All Cementless Components versus Hybrid Fixation (Cementless
Femoral Component)
• Unicompartmental knee arthroplasty (medial or lateral tibiofemoral joint, not
patellofemoral)
o UKA: DVT & Manipulation Under Anesthesia
o UKA Versus Osteotomy
• Realignment Osteotomy (varus or valgus producing femoral or tibial osteotomy)
o UKA Versus Osteotomy
DETERMINING APPROPRIATENESS VOTING PANEL
A multidisciplinary panel of clinicians was assembled to determine the appropriateness of
treatments for the SMOAK AUC. A non-voting moderator, who is an orthopaedic surgeon, but is
not a specialist in the treatment of osteoarthritis of the knee, moderated the voting panel. The
moderator was familiar with the methods and procedures of AAOS Appropriate Use Criteria and
led the panel (as a non-voter) in discussions. Additionally, no member of the voting panel was
involved in the development (writing panel) of the scenarios.
The voting panel used a modified Delphi procedure to determine appropriateness ratings. The
voting panel participated in three rounds of voting while considering evidence-based information
provided in the literature review. While cost is often a relevant consideration, panelists focused
their appropriateness ratings on the effectiveness of surgical treatment for osteoarthritis of the
knee.
RATING APPROPRIATENESS
When rating the appropriateness of a scenario, the voting panel considered the following
definition:
“An appropriate surgical treatment for osteoarthritis of the knee is one for which the
treatment is generally acceptable, is a reasonable approach for the indication, and is likely to
improve the patient’s health outcomes or survival.”
They then rated each scenario using their best clinical judgment, taking into consideration the
available evidence, for an average patient presenting to an average physician at an average
facility as follows:
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9 AAOS Evidence-Based Medicine Unit
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Table 1 Interpreting the 9-Point Appropriateness Scale
Rating Explanation
7-9
Appropriate:
Appropriate for the indication provided, meaning treatment is
generally acceptable and is a reasonable approach for the
indication and is likely to improve the patient’s health outcomes
or survival.
4-6
May Be Appropriate:
Uncertain for the indication provided, meaning treatment may
be acceptable and may be a reasonable approach for the
indication, but with uncertainty implying that more research
and/or patient information is needed to further classify the
indication.
1-3
Rarely Appropriate:
Rarely an appropriate option for management of patients in this
population due to the lack of a clear benefit/risk advantage;
rarely an effective option for individual care plans; exceptions
should have documentation of the clinical reasons for
proceeding with this care option (i.e. procedure is not generally
acceptable and is not generally reasonable for the indication).
Each panelist uses the scale below to record their response for each scenario:
Appropriateness of [Topic]
1 2 3 4 5 6 7 8 9
ROUND ONE VOTING
The first round of voting occurred after completion of the independent review of the scenarios by
the review panel and approval of the final indications, scenarios, and assumptions by the writing
panel. The voting panel rated the scenarios electronically using a personalized ballot created by
AAOS staff using the AAOS AUC Electronic Ballot Tool. There was no interaction between
panel members while completing the first round of voting. Panelists considered the following
materials:
• The instructions for rating appropriateness
May Be Appropriate Appropriate Rarely Appropriate
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10 AAOS Evidence-Based Medicine Unit
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• The completed literature review, that is appropriately referenced when evidence is
available for a scenario
• The list of indications, definitions, and assumptions, to ensure consistency in the
interpretation of the clinical scenarios
ROUNDS TWO AND THREE VOTING
The second round of voting occurred during the in-person voting panel meeting on August 5th,
2016. Before the in-person meeting started, each panelist received a personalized document that
included their first round ratings along with summarized results of the first-round ratings that
resulted in disagreement. These results indicated the frequency of ratings for a scenario for all
panelists. The document contained no identifying information for other panelists’ ratings. The
moderator also used a document that summarized the results of the panelists’ first round voting.
These personalized documents served as the basis for discussions of scenarios which resulted in
disagreement.
During the discussion, the voting panel members were allowed to add or edit the assumptions
list, patient indications, and/or treatments if clarification was needed. They were also asked to
record a new rating for any scenarios/treatments, only if they were persuaded to do so by the
discussion and/or the evidence. There was no attempt to obtain consensus among the panel
members.
Upon completion of the second round of voting, AAOS staff and moderators used the AAOS
AUC Electronic Ballot Tool to again identify any statistical disagreements. After discussing
these again, and at the request of the voting panel, the ballots were opened for a third round of
voting. No voter was forced to participate in this round of voting and there was no attempt to
obtain consensus among the panel members. After the final ratings were submitted, AAOS staff
used the AAOS AUC Electronic Ballot Tool to export the median values and level of agreement
for all voting items.
FINAL RATINGS
Using the median value of the third round ratings, AAOS staff determined the final levels of
appropriateness. Disagreement among raters can affect the final rating. Agreement and
disagreement were determined using the BIOMED definitions of Agreement and Disagreement,
as reported in the RAND/UCLA Appropriate Method User’s Manual 2, for a panel of 11-13
voting members (see Table 2 below). The 11-13 panel member disagreement cutoff was used for
this voting panel. For this panel size, disagreement is defined as when ≥ 4 members’
appropriateness ratings fell within the appropriate (7-9) and rarely appropriate (1-3) ranges for
any scenario (i.e. ≥ 4 members’ ratings fell between 1-3 and ≥ 4 members’ ratings fell between
7-9 on any given scenario and its treatment). If there is still disagreement in the voting panel
ratings after the last round of voting, that voting item is labeled as “5” regardless of median
score. Agreement is defined as ≤ 3 panelists rated outside of the 3-point range containing the
median.
Table 2 Defining Agreement and Disagreement for Appropriateness Ratings
Disagreement Agreement
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11 AAOS Evidence-Based Medicine Unit
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Panel Size Number of panelists rating in
each extreme (1-3 and 7-9)
Number of panelists rating
outside the 3-point region
containing the median (1-3,
4-6, 7-9)
8,9,10 ≥ 3 ≤ 2
11,12,13 ≥ 4 ≤ 3
14,15,16 ≥ 5 ≤ 4
Adapted from RAM 1
The classifications in the table below determined final levels of appropriateness.
Table 3 Interpreting Final Ratings of Criteria
Level of Appropriateness Description
Appropriate • Median panel rating between 7-9 and no disagreement
May Be Appropriate • Median panel rating between 4-6 or
• Median panel rating 1-9 with disagreement
Rarely Appropriate • Median panel rating between 1-3 and no disagreement
REVISION PLANS These criteria represent a cross-sectional view of current use of treatments for osteoarthritis of
the knee and may become outdated as new evidence becomes available or clinical decision
making indicators are improved. In accordance with the standards of the National Guideline
Clearinghouse, AAOS will update or withdraw these criteria in five years. AAOS will issue
updates in accordance with new evidence, changing practice, rapidly emerging treatment options,
and new technology.
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12 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
DISSEMINATING APPROPRIATE USE CRITERIA
All AAOS AUCs can be accessed via a user-friendly app that is available via the
OrthoGuidelines website (www.orthoguidelines.org/auc) or as a native app via the Apple and
Google Play stores.
Publication of the Appropriate Use Criteria (AUC) document is on the AAOS website at
[http://www.aaos.org/auc]. This document provides interested readers with full documentation
about the development of Appropriate Use Criteria and further details of the criteria ratings.
AUCs are first announced by an Academy press release and then published on the AAOS
website. AUC summaries are published in the AAOS Now and the Journal of the American
Academy of Orthopaedic Surgeons (JAAOS). In addition, the Academy’s Annual Meeting
showcases the AUCs on Academy Row and at Scientific Exhibits.
The dissemination efforts of AUC include web-based mobile applications, webinars, and online
modules for the Orthopaedic Knowledge Online website, radio media tours, and media briefings.
In addition AUCs are also promoted in relevant Continuing Medical Education (CME) courses
and distributed at the AAOS Resource Center.
Other dissemination efforts outside of the AAOS include submitting AUCs to the National
Guideline Clearinghouse and to other medical specialty societies’ meetings.
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13 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
III. PATIENT INDICATIONS AND TREATMENTS
INDICATIONS Table 4 Patient Indications and Classifications
Indication Classification(s)
Function-Limiting Pain
a. Function-limiting pain at moderate to long distances
(walking moderate to long distances greater than ¼ mile)
b. Function-limiting pain at short distances (limiting activity
to two city blocks, the equivalent to walking the length of a
shopping mall)
c. Pain at rest or night
Range of Motion Extension/Flexion
a. Full range of extension/flexion
b. Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees
c. Lack of full extension (>10 degree flexion contracture)
and/or flexion <90 degrees
Functional Instability
(not to include antalgic giving way)
a. No functional instability
b. Functional instability
Pattern of arthritic involvement
(medial tibiofemoral, lateral tibiofemoral or
patellofemoral)
a. Predominantly one compartment
b. More than one compartment
Imaging
(joint space in most involved compartment)
a. Mild to moderate
b. Severe
Limb Alignment
a. Normal Alignment
b. Varus/ valgus
Mechanical Symptoms
(compatible with Meniscal Tear or Loose Body)
a. Yes
b. No
Age
a. Young
b. Middle-aged
c. Elderly
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14 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
TREATMENTS Treatments Addressed Within This AUC
1. Total knee arthroplasty
2. Unicompartmental knee arthroplasty (medial or lateral tibiofemoral joint, not
patellofemoral)
3. Realignment Osteotomy (varus or valgus producing femoral or tibial osteotomy)
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15 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
IV. RESULTS OF APPROPRIATENESS RATINGS
For a user-friendly version of these appropriate use criteria, please access our AUC web-based
application at www.orthoguidelines.org/auc. The OrthoGuidelines native app can also be
downloaded via the Apple or Google Play stores.
Web-Based AUC Application Screenshot
Click Here to Access the AUC App!
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16 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
Results
The following Appropriate Use Criteria tables contain the final appropriateness ratings assigned
by the eight members of the voting panel. Patient characteristics are found under the column titled
“Scenario”. The Appropriate Use Criteria for each patient scenario can be found within each of
the 6 treatment rows. These criteria are formatted by appropriateness labels (i.e. “R”=Rarely
Appropriate, “M”=May Be Appropriate, and “A”=Appropriate), median rating, and + or -
indicating agreement or disagreement amongst the voting panel, respectively.
Out of 2592 total voting items (i.e. 864 patient scenarios x 3 treatments), 537 (21%) voting items
were rated as “Appropriate”, 645 (25%) voting items were rated as “May Be Appropriate”, and
1410 (54%) voting items were rated as “Rarely Appropriate” (Figure 1). Additionally, the voting
panel members were in statistical agreement on 1413 (55%) voting items and were in statistical
disagreement 0 voting items (Figure 2).
Figure 1. Breakdown of Appropriateness Ratings
Appropriate
21%
Maybe
Appropriate
25%
Rarely
Appropriate
54%
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17 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
Figure 2. Breakdown of Agreement amongst Voting Panel
Agree
55%
Disagree
0%
Neither
45%
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18 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
Figure 3. Distribution of Appropriateness Ratings on 9-Point Rating Scale
0
100
200
300
400
500
600
700
800
900
1 2 3 4 5 6 7 8 9
816
380
214 228195
222256
211
70
Rarely Appropriate
May Be Appropriate Appropriate
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19 AAOS Evidence-Based Medicine Unit
www.orthoguidelines.org/auc or download the OrthoGuidelines app via Apple or Google Play stores
Figure 4. Within Treatment Appropriateness Ratings
0
100
200
300
400
500
600
700
800
Realignment Osteotomy (varus
or valgus producing femoral or
tibial osteotomy)
Total knee arthroplasty Unicompartmental knee
arthroplasty (medial or lateral
tibiofemoral joint, not
patellofemoral)
5
496
36
119
313
213
740
55
615
Appropriate Maybe Appropriate Rarely Appropriate
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20
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
APPROPRIATE USE CRITERIA FOR THE SURGICAL MANAGEMENT OF OSTEOARTHRITIS OF
THE KNEE
Interpreting the AUC tables:
➢ R = Rarely Appropriate, M = May Be Appropriate, A = Appropriate
➢ Numbers under “M” column indicate the median rating of voting panel
➢ A plus symbol (+) indicates agreement between voting panel members and a minus symbol (-) indicates disagreement between
voting panel members
Scenario 1: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 2 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 2: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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21
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 3: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 4: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 2
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 5: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Rarely Appropriate 2
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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22
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 6: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 7: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 2 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 8: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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23
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 9: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 10: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 2
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 11: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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24
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 12: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 13: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 14: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 32: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/32.jpg)
25
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 15: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 16: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 17: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 33: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/33.jpg)
26
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 18: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 19: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 20: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
![Page 34: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/34.jpg)
27
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 21: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
Scenario 22: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 23: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
![Page 35: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/35.jpg)
28
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 24: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 25: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 26: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 36: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/36.jpg)
29
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 27: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 28: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 29: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 37: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/37.jpg)
30
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 30: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 31: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 32: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 38: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/38.jpg)
31
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 33: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 34: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 35: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 39: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/39.jpg)
32
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 36: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 37: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 38: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 40: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/40.jpg)
33
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 39: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 40: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 41: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 41: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/41.jpg)
34
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 42: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 43: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 44: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 42: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/42.jpg)
35
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 45: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 46: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 47: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 43: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/43.jpg)
36
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 48: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, No functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 49: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 50: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
![Page 44: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/44.jpg)
37
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 51: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 52: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 53: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 45: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/45.jpg)
38
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 54: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 55: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5 +
Scenario 56: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 46: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/46.jpg)
39
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 57: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 58: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty Rarely Appropriate 2
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 59: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 47: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/47.jpg)
40
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 60: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 61: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 62: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 48: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/48.jpg)
41
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 63: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 64: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 65: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 49: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/49.jpg)
42
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 66: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 67: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 68: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
![Page 50: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/50.jpg)
43
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 69: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 70: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 71: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
![Page 51: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/51.jpg)
44
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 72: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, Predominantly
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 73: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 74: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 52: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/52.jpg)
45
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 75: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 76: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 77: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 53: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/53.jpg)
46
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 78: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 79: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 80: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 54: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/54.jpg)
47
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 81: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 82: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 83: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 55: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/55.jpg)
48
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 84: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 85: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 86: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 56: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/56.jpg)
49
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 87: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 88: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 89: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 57: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/57.jpg)
50
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 90: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 91: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 92: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 58: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/58.jpg)
51
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 93: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 94: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 95: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 59: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/59.jpg)
52
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 96: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Full
range of extension/flexion, Functional instability, More than one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 97: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 98: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
![Page 60: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/60.jpg)
53
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 99: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 100: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 101: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
![Page 61: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/61.jpg)
54
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 102: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 103: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 104: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 62: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/62.jpg)
55
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 105: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 106: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 107: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
![Page 63: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/63.jpg)
56
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 108: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 109: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 110: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 64: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/64.jpg)
57
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 111: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 112: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 113: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 65: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/65.jpg)
58
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 114: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 115: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 116: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
![Page 66: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/66.jpg)
59
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 117: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 118: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 119: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
![Page 67: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/67.jpg)
60
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 120: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 121: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 122: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 68: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/68.jpg)
61
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 123: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 124: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 125: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 69: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/69.jpg)
62
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 126: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 127: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 128: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 70: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/70.jpg)
63
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 129: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 130: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 131: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 71: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/71.jpg)
64
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 132: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 133: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 134: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 72: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/72.jpg)
65
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 135: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 136: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 137: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 73: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/73.jpg)
66
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 138: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 139: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 140: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 74: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/74.jpg)
67
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 141: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 142: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 143: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 75: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/75.jpg)
68
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 144: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 145: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 146: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 76: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/76.jpg)
69
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 147: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 148: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 149: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
![Page 77: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/77.jpg)
70
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 150: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 151: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 152: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 78: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/78.jpg)
71
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 153: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 154: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 155: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 79: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/79.jpg)
72
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 156: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 157: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 158: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 80: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/80.jpg)
73
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 159: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 160: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 161: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 81: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/81.jpg)
74
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 162: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 163: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 164: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
![Page 82: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/82.jpg)
75
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 165: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 166: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 167: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
![Page 83: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/83.jpg)
76
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 168: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 169: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 170: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 84: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/84.jpg)
77
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 171: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 172: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 173: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 85: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/85.jpg)
78
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 174: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 175: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 176: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 86: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/86.jpg)
79
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 177: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 178: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 179: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 87: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/87.jpg)
80
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 180: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 181: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 182: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 88: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/88.jpg)
81
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 183: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 184: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 185: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, No Mechanical Symptoms, Middle-
aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 89: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/89.jpg)
82
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 186: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 187: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 188: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 90: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/90.jpg)
83
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 189: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 190: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, No Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 191: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 91: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/91.jpg)
84
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 192: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 5 degree flexion contracture) and/or flexion <
110 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 193: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 194: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
![Page 92: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/92.jpg)
85
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 195: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 196: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 197: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
![Page 93: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/93.jpg)
86
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 198: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 199: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 200: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
![Page 94: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/94.jpg)
87
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 201: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 202: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 203: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 95: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/95.jpg)
88
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 204: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 205: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 206: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 96: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/96.jpg)
89
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 207: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 208: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 209: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 97: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/97.jpg)
90
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 210: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 211: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 212: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
![Page 98: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/98.jpg)
91
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 213: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 214: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 215: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 99: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/99.jpg)
92
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 216: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 217: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 218: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 100: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/100.jpg)
93
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 219: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 220: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 221: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 101: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/101.jpg)
94
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 222: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 223: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 224: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 102: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/102.jpg)
95
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 225: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 226: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 227: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 103: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/103.jpg)
96
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 228: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 229: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 230: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 104: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/104.jpg)
97
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 231: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 232: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 233: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 105: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/105.jpg)
98
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 234: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 235: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 236: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 106: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/106.jpg)
99
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 237: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 238: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 239: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 107: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/107.jpg)
100
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 240: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, No functional instability, More than one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 241: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 242: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1
![Page 108: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/108.jpg)
101
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 243: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 244: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 245: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1
![Page 109: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/109.jpg)
102
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 246: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 247: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 248: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
![Page 110: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/110.jpg)
103
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 249: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 250: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 251: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
![Page 111: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/111.jpg)
104
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 252: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 253: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 254: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 112: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/112.jpg)
105
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 255: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 256: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 257: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 113: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/113.jpg)
106
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 258: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 259: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 260: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
![Page 114: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/114.jpg)
107
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 261: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 262: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 263: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 115: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/115.jpg)
108
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 264: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, Predominantly one
compartment, Severe, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 265: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 266: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 116: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/116.jpg)
109
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 267: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 268: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 269: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 117: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/117.jpg)
110
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 270: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Normal Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 271: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 272: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 118: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/118.jpg)
111
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 273: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 274: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 275: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 119: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/119.jpg)
112
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 276: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Mild to moderate , Joint space narrowing as visible on imaging,
Varus/ valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 277: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 278: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 120: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/120.jpg)
113
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 279: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 280: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 281: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, No Mechanical Symptoms, Middle-
aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 121: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/121.jpg)
114
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 282: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Normal Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 283: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 284: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 122: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/122.jpg)
115
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 285: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 286: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, No Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 287: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 123: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/123.jpg)
116
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 288: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at moderate to long distances (walking
moderate to long distances greater than one fourth mile), Lack of
full extension (> 10 degree flexion contracture) and/or flexion <
90 degrees, Functional instability, More than one compartment,
Severe, Varus/ valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 289: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 2
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 290: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 124: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/124.jpg)
117
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 291: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 292: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 2
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 293: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 125: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/125.jpg)
118
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 294: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 295: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 2
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Appropriate 7
Scenario 296: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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119
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 297: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 298: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Appropriate 7
Scenario 299: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
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120
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 300: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 301: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 302: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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121
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 303: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 304: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 305: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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122
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 306: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 307: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 308: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
![Page 130: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/130.jpg)
123
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 309: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 310: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Appropriate 8
Scenario 311: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
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124
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 312: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 313: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 314: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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125
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 315: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 316: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 317: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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126
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 318: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 319: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 320: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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127
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 321: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 322: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 323: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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128
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 324: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 325: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 326: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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129
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 327: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 328: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 329: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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130
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 330: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 331: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 332: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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131
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 333: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 334: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 335: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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132
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 336: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, No functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 337: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 338: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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133
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 339: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 340: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 341: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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134
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 342: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 343: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 344: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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135
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 345: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 346: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 347: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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136
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 348: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 349: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 350: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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137
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 351: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 352: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 353: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
![Page 145: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/145.jpg)
138
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 354: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 355: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 356: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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139
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 357: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 358: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 359: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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140
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 360: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 361: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 362: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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141
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 363: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 364: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 365: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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142
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 366: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 367: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 368: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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143
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 369: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 370: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 371: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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144
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 372: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 373: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 374: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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145
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 375: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 376: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 377: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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146
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 378: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 379: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 380: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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147
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 381: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 382: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 383: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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148
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 384: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Full range of extension/flexion, Functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 385: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 386: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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149
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 387: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 388: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 389: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
![Page 157: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/157.jpg)
150
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 390: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 391: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 392: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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151
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 393: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 394: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 395: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
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152
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 396: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 397: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 398: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 8 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
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153
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 399: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 400: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 401: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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154
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 402: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 403: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5 +
Scenario 404: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
![Page 162: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/162.jpg)
155
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 405: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 406: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 407: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
![Page 163: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/163.jpg)
156
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 408: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 409: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 410: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 164: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/164.jpg)
157
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 411: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 412: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 413: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 165: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/165.jpg)
158
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 414: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 415: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 416: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 166: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/166.jpg)
159
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 417: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 418: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 419: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 167: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/167.jpg)
160
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 420: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Mild to moderate , Joint space narrowing
as visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 421: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 422: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 168: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/168.jpg)
161
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 423: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 424: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 425: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 169: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/169.jpg)
162
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 426: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 427: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 428: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 170: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/170.jpg)
163
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 429: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 430: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 431: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 171: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/171.jpg)
164
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 432: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, No functional instability, More
than one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 433: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 434: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1
![Page 172: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/172.jpg)
165
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 435: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 436: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1
Scenario 437: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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166
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 438: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 439: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 440: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 174: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/174.jpg)
167
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 441: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 442: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 443: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 175: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/175.jpg)
168
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 444: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 445: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 446: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 176: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/176.jpg)
169
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 447: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 448: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 449: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
![Page 177: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/177.jpg)
170
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 450: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 451: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 452: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
![Page 178: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/178.jpg)
171
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 453: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 454: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 455: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
![Page 179: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/179.jpg)
172
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 456: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 457: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 458: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 180: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/180.jpg)
173
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 459: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 460: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 461: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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174
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 462: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 463: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 464: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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175
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 465: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 466: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 467: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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176
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 468: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 469: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 470: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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177
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 471: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 472: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 473: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 185: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/185.jpg)
178
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 474: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 475: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 476: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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179
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 477: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 478: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 479: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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180
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 480: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 5 degree flexion contracture)
and/or flexion < 110 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 481: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 482: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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181
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 483: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 484: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 485: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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182
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 486: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 487: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 488: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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183
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 489: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 490: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 491: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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184
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 492: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 493: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 494: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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185
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 495: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 496: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 497: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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186
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 498: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 499: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 500: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
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187
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 501: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 502: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 503: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
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188
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 504: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 505: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 506: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 196: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/196.jpg)
189
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 507: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 508: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 509: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 197: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/197.jpg)
190
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 510: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 511: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 512: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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191
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 513: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 514: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 515: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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192
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 516: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 517: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 518: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 200: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/200.jpg)
193
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 519: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 520: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 521: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 201: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/201.jpg)
194
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 522: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 523: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 524: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 202: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/202.jpg)
195
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 525: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 526: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 527: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 203: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/203.jpg)
196
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 528: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, No functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 529: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
Scenario 530: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1
![Page 204: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/204.jpg)
197
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 531: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 532: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 533: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 205: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/205.jpg)
198
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 534: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 535: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 536: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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199
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 537: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 538: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 539: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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200
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 540: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 541: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 542: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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201
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 543: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 544: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 545: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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202
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 546: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 547: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 548: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
![Page 210: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/210.jpg)
203
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 549: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 550: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 551: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 211: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/211.jpg)
204
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 552: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 553: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 554: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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205
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 555: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 556: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 557: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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206
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 558: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 559: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 560: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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207
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 561: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 562: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 563: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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208
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 564: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Mild to moderate , Joint space narrowing as
visible on imaging, Varus/ valgus, No Mechanical Symptoms,
Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 565: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 566: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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209
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 567: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 568: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 569: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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210
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 570: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Normal Alignment, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 571: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 572: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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211
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 573: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 574: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 575: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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212
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 576: Treatment Appropriateness Median
Rating Agreement
Function-limiting pain at short distances (limiting activity to two
city blocks, the equivalent to walking the length of a shopping
mall), Lack of full extension (> 10 degree flexion contracture)
and/or flexion < 90 degrees, Functional instability, More than
one compartment, Severe, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 577: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 578: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
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213
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 579: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 580: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 581: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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214
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 582: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 583: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 584: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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215
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 585: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 586: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, No Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 587: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
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216
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 588: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 589: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Normal Alignment, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 590: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Normal Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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217
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 591: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Normal Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 592: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Normal Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 593: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Normal Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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218
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 594: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Normal Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 595: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Varus/ valgus, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 596: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Varus/ valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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219
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 597: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Varus/ valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 598: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Varus/ valgus, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 599: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Varus/ valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
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220
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 600: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, Predominantly one compartment, Severe,
Varus/ valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 601: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 602: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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221
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 603: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 604: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 605: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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222
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 606: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Normal
Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 607: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 608: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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223
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 609: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 610: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 611: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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224
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 612: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Mild to
moderate , Joint space narrowing as visible on imaging, Varus/
valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 613: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Normal Alignment, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 614: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Normal Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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225
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 615: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Normal Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 616: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Normal Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 617: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Normal Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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226
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 618: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Normal Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 619: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Varus/ valgus, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 620: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Varus/ valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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227
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 621: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Varus/ valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 622: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Varus/ valgus, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 623: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Varus/ valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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228
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 624: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, No
functional instability, More than one compartment, Severe,
Varus/ valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 625: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 626: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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229
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 627: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 628: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 629: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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230
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 630: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 631: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 632: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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231
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 633: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 634: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
Scenario 635: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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232
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 636: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 637: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 638: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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233
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 639: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 640: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 641: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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234
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 642: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 643: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Varus/
valgus, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 644: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Varus/
valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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235
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 645: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Varus/
valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 646: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Varus/
valgus, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 647: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Varus/
valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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236
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 648: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, Predominantly one compartment, Severe, Varus/
valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 649: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 650: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 244: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/244.jpg)
237
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 651: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 652: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 653: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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238
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 654: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 655: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 656: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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239
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 657: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 658: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 659: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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240
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 660: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 661: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 662: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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241
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 663: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 664: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 665: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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242
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 666: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 667: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 668: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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243
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 669: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 670: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Varus/ valgus,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 671: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Varus/ valgus,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 251: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/251.jpg)
244
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 672: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Full range of extension/flexion, Functional
instability, More than one compartment, Severe, Varus/ valgus,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 673: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 674: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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245
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 675: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 676: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 677: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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246
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 678: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 679: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 680: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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247
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 681: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 682: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 6
Scenario 683: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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248
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 684: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 685: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 686: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
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249
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 687: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 688: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 689: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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250
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 690: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 691: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Appropriate 7
Scenario 692: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Appropriate 7
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
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251
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 693: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 694: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Appropriate 7
Scenario 695: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 6
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 5
![Page 259: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/259.jpg)
252
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 696: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 697: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 698: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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253
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 699: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 700: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 701: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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254
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 702: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 703: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 704: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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255
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 705: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 706: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 707: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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256
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 708: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 709: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 710: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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257
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 711: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 712: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 713: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 265: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/265.jpg)
258
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 714: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 715: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 716: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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259
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 717: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 718: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 719: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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260
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 720: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 721: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
Scenario 722: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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261
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 723: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 724: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 725: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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262
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 726: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 727: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 728: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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263
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 729: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 730: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 731: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
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264
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 732: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 733: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 734: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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265
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 735: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 736: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 737: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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266
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 738: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 739: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 740: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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267
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 741: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 742: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 743: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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268
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 744: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 745: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 746: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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269
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 747: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 748: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 749: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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270
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 750: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 751: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 752: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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271
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 753: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 754: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 755: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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272
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 756: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 757: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 758: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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273
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 759: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 760: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 761: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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274
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 762: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 763: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 764: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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275
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 765: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 766: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 767: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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276
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 768: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 5 degree flexion
contracture) and/or flexion < 110 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 769: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 770: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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277
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 771: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 772: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 773: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
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278
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 774: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 775: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 776: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
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279
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 777: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 778: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
May Be Appropriate 4
Scenario 779: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3 +
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280
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 780: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Mild to moderate ,
Joint space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 781: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 782: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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281
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 783: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 784: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 785: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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282
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 786: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 787: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 788: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 5
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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283
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 789: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 790: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 791: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
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284
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 792: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, Predominantly one compartment, Severe, Varus/
valgus, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 793: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 794: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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285
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 795: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 796: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 797: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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286
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 798: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 799: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 800: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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287
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 801: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 802: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 803: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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288
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 804: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Mild to moderate , Joint
space narrowing as visible on imaging, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 805: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 806: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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289
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 807: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 808: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 809: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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290
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 810: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Normal
Alignment, No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 811: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 812: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 298: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/298.jpg)
291
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 813: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 814: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
No Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 815: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 299: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/299.jpg)
292
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 816: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, No functional
instability, More than one compartment, Severe, Varus/ valgus,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 817: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 818: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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293
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 819: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 820: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 821: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 301: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/301.jpg)
294
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 822: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 823: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty Rarely Appropriate 3
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 3
Scenario 824: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 302: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/302.jpg)
295
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 825: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 826: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2
Scenario 827: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 303: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/303.jpg)
296
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 828: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 829: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 830: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 304: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/304.jpg)
297
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 831: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 832: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 833: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
![Page 305: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/305.jpg)
298
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 834: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Normal Alignment,
No Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 835: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 836: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 306: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/306.jpg)
299
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 837: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 838: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
May Be Appropriate 4
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 839: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 3
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
![Page 307: APPROPRIATE USE CRITERIA FOR THE SURGICAL ......Kevin Shea, MD Chair, AAOS Council on Research and Quality David Jevsevar, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director](https://reader034.vdocuments.us/reader034/viewer/2022042207/5eaa404ddd7c93183627fa73/html5/thumbnails/307.jpg)
300
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 840: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
Predominantly one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 841: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 4
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 842: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 843: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 844: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 845: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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302
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 846: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 847: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 2 +
Scenario 848: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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303
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 849: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 850: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 5
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 851: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 2 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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304
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 852: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Mild to moderate , Joint space
narrowing as visible on imaging, Varus/ valgus, No Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 853: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 854: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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305
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 855: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment,
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 856: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Young
Total knee arthroplasty Appropriate 7
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 857: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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306
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 858: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Normal Alignment, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 859: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 860: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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307
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 861: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, Mechanical
Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 862: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Young
Total knee arthroplasty May Be Appropriate 6
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
Scenario 863: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Middle-aged
Total knee arthroplasty Appropriate 8 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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308
AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
Scenario 864: Treatment Appropriateness Median
Rating Agreement
Pain at rest or night, Lack of full extension (> 10 degree flexion
contracture) and/or flexion < 90 degrees, Functional instability,
More than one compartment, Severe, Varus/ valgus, No
Mechanical Symptoms, Elderly
Total knee arthroplasty Appropriate 9 +
Unicompartmental knee
arthroplasty (medial or
lateral tibiofemoral joint, not
patellofemoral)
Rarely Appropriate 1 +
Realignment Osteotomy
(varus or valgus producing
femoral or tibial osteotomy)
Rarely Appropriate 1 +
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AAOS Evidence-Based Medicine Unit
AAOS AUC Web-Based Application: www.aaos.org/aucapp
V. APPENDICES
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APPENDIX A. DOCUMENTATION OF APPROVAL
AAOS BODIES THAT APPROVED THIS APPROPRIATE USE CRITERIA
Evidence-Based Quality and Value Committee: Approved on 9/10/2016
The AAOS Committee on Evidence Based Quality and Value consists of 22 AAOS members. The
overall purpose of this committee is to plan, organize, direct, and evaluate initiatives related to
Clinical Practice Guidelines and Appropriate Use Criteria.
Council on Research and Quality: Approved on 10/14/2016
To enhance the mission of the AAOS, the Council on Research and Quality promotes the most
ethically and scientifically sound basic, clinical, and translational research possible to ensure the
future care for patients with musculoskeletal disorders. The Council also serves as the primary
resource to educate its members, the public, and public policy makers regarding evidenced-based
medical practice, orthopaedic devices and biologics regulatory pathways and standards development,
patient safety, occupational health, technology assessment, and other related areas of importance.
Board of Directors: Approved on 12/09/2016
The 16 member AAOS Board of Directors manages the affairs of the AAOS, sets policy, and
determines and continually reassesses the Strategic Plan.
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APPENDIX B. DISCLOSURE INFORMATION
SMOAK AUC WRITING PANEL
Paul A Manner, MD Submitted on: 06/02/2015
Clinical Orthopaedics and Related Research: Editorial or governing board ($60,000) Senior Editor(Self);
JointMetrix Medical: Employee ($0) Chief Medical Officer(Self)
Bryan Bomberg, MD Submitted on: 07/08/2015
DJ Orthopaedics: Paid consultant ($0); DJ Orthopaedics: Other financial or material support ($0);
Medtronic: Paid consultant ($0)
Samuel Mc Comas Hawken, MD Submitted on: 08/14/2015
Biomet: Stock or stock Options Number of Shares: 0
Tamara Nicole Huff, MD (This individual reported nothing to disclose); Submitted on: 07/18/2015
Charles L Nelson, MD Submitted on: 08/13/2015
American Association of Hip and Knee Surgeons: Board or committee member ($0) Committee
Member(Self); J. Robert Gladden Society: Board or committee member ($0) (Self); Zimmer: Paid
consultant ($35,875) Consultant(Self)
David T Neuman, MD (This individual reported nothing to disclose); Submitted on: 08/06/2015
Frederick Buechel, Jr MD Submitted on: 11/26/2014
Stryker: Paid presenter or speaker ($0) Number of Presentations: 0; Stryker: Paid consultant ($0)
Brett Russell Levine, MD Submitted on: 08/15/2015
American Association of Hip and Knee Surgeons: Board or committee member ($0) Patient Education
Committee(Self); Biomet: Research support ($10,000) Receive research money for cemented and
cementless THA research projects; CORD: Board or committee member ($0) Education Committee
Member (CORD Report Liason)(Self); Human kinetics: Editorial or governing board ($500) Author of
book (Self); Link Orthopaedics: Paid consultant ($10,000) Surgeon Consultant(Self); McGraw-Hill: Paid
consultant ($3,500) Question Editor(Self); Orthoview: Paid consultant ($2,500) Product develop and
training(Self); SLACK Incorporated: Editorial or governing board ($0) Publishing a board review book.
not yet completed.; Zimmer: Paid consultant ($35,000) Consultant--Surgeon and Resident
Education(Self); Zimmer: Research support ($0) Institutional research money is received. Nothing is
directly given to me or myresearch funds.(Self)
Adolph J Yates Jr, MD Submitted on: 08/08/2015
American Association of Hip and Knee Surgeons: Board or committee member ($0) committee chair,
EBM Report
Louis F McIntyre, MD Submitted on: 04/09/2015
AAOS: Board or committee member ($0);
Advocacy for Improvement in Mobility: Board or committee member ($0);
Arthroscopy Association of North America: Board or committee member ($0);
Delegate Medical Society of the State of New York: Board or committee member ($0);
DePuy, A Johnson & Johnson Company: Research support ($0);
Orthopedic Practice Management, Inc.: Board or committee member ($0);
Orthopedics Today: Editorial or governing board ($0);
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Quintiles Medical: Paid presenter or speaker ($0) Number of Presentations: 0;
Tornier: Stock or stock Options Number of Shares: 0
SMOAK AUC VOTING PANEL
Brandon Dubose Bushnell, MBA, MD: AAOS: Board or committee member; Arthroscopy Association
of North America: Board or committee member; Georgia Orthopedic Society: Board or committee
member; Mitek: Paid consultant; Rotation Medical: Paid consultant; Research support; Submitted on:
05/02/2016
Kim J Chillag, MD: Clinical Orthopaedics and Related Research: Editorial or governing board; Journal
of Arthroplasty: Editorial or governing board; Submitted on: 05/30/2016
Dennis C Chin, MD: Smith & Nephew: Employee; Submitted 04/06/2016
Marc M DeHart, MD: Board Member, Texas Orthopaedic Association: Board or committee member;
Journal of Arthroplasty: Editorial or governing board; Speaker honorarium for Orthopaedic Review
Courses: Publishing royalties, financial or material support; Submitted on: 04/04/2016
Morgan H Jones, MD: American Orthopaedic Society for Sports Medicine: Board or committee
member; Orthopaedic Journal of Sports Medicine: Editorial or governing board; Submitted on:
06/03/2016
Claudette Lajam, MD: AAOS: Board or committee member; International Orthopaedics: Editorial or
governing board; Journal of Arthroplasty: Editorial or governing board; My home hospital journal:
Editorial or governing board; Pfizer: Employee; Stock or stock Options; Ruth Jackson Orthopaedic
Society: Board or committee member; Stryker: Paid consultant; Submitted on: 04/21/2016
Gwo-Chin Lee, MD: AAOS: Board or committee member; CD Diagnostics: Research support
Ceramtec: Paid presenter or speaker; Clinical Orthopaedics and Related Research: Editorial or governing
board; DePuy, A Johnson & Johnson Company: Paid consultant; Paid presenter or speaker; Journal of
Arthroplasty: Editorial or governing board; Journal of Bone and Joint Surgery: Editorial or governing
board; Orthopedics: Editorial or governing board; Pacira: Paid consultant; SLACK Incorporated: Editorial
or governing board; Smith and Nephew: Research support; Stryker: Paid consultant; Zimmer: Research
support; Submitted on: 05/31/2015
John R Martell Jr, MD: (This individual reported nothing to disclose); Submitted on: 04/04/2016
Neil Segal, MD: American Academy of Physical Medicine & Rehabilitation: Board or committee
member; Association of Academic Physiatrists: Board or committee member; Myoscience: Research
support; Orthotrophix: Research support; Springer: Publishing royalties, financial or material support;
Submitted on: 04/01/2016
Steven Alan Silver, MD: (This individual reported nothing to disclose); Submitted on: 05/12/2016
Creighton Collins Tubb, MD: AAOS: Board or committee member; American Association of Hip and
Knee Surgeons: Board or committee member; Submitted on: 06/11/2016
Moderators
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Robert H Quinn, MD: AAOS: Board or committee member; American Orthopaedic Association: Board
or committee member; Journal of Wilderness & Environmental Medicine: Editorial or governing board;
Musculoskeletal Transplant Foundation: Research support; Musculoskeletal Tumor Society: Board or
committee member; Wilderness Medical Society: Board or committee member; Submitted on:
05/24/2016
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APPENDIX C. REFERENCES
(1) American Academy of Orthopaedic Surgeons. The Burden of Musculoskeletal Diseases
in the United States. American Academy of Orthopaedic Surgeons; 2008.
(2) Fitch K, Bernstein SJ, Aguilar MD et al. The RAND/UCLA Appropriateness Method
User's Manual. Santa Monica, CA: RAND Corporation; 2001.
(3) American Academy of Orthopaedic Surgeons. Surgical Management of Osteoarthritis of
the Knee Clinical Practice Guideline. http://www.orthoguidelines.org/smoakguideline.
Published December 4, 2015.