PURPOSE The Appropriate Use Criteria (AUC) for the surgical treatment of knee osteoarthritis were developed by the American Academy of Orthopedic Surgeons (AAOS) to guide surgeons in selecting the most evidence-based surgical option. This study aimed to assess the usability of the AUC by comparing the actual surgical treatment provided at our institution with that recommended by the AUC. METHODS A retrospective review of the medical charts and radiographs of all patients who underwent surgery for knee osteoarthritis (OA) at our hospital was performed between January and December 2017. Data including each patient's age, gender, pain level, mechanical symptoms, range of motion (ROM) and instability, radiographic pattern and severity, limb alignment, and type of surgical interventions received were collected. The collected data were input into the AUC application to determine the rate of appropriateness of the treatments. Afterwards, the agreement between the actual treatment provided and the AUC recommendation was assessed. RESULTS A consecutive series of 100 patients were included. The mean age was 63.1 years, with the majority of the patients aged (73%) between 50 and 69 years. Most of the patients were females (74%), and 61% had left knee OA. The most frequent type of patient was a middle-aged patient with function-limiting pain at short distances, no mechanical symptoms or functional instability with full ROM, severe knee multicompartmental radiographic features, and varus or valgus malalignment. Out of the 100 patients, total knee arthroplasty (TKA) was performed in 85 patients, unicompartmental knee arthroplasty (UKA) was performed in 11 patients, and high tibial osteotomy (HTO) was performed in four patients. According to the AUC, 90 (90%) cases were treated with an appropriate surgical treatment, whereas 10 (10%) cases were treated with a maybe appropriate treatment. The actual surgical treatment performed at our hospital was in agreement with the AUC recommendation in 100% of the TKA cases, 90.9% of the UKA cases, and 100% of the HTO cases. Thus, the agreement rate with the AUC was 99% in all surgical cases. CONCLUSION This study demonstrated that the AUC for the surgical treatment of knee OA can be applied easily in a clinical setting. Most of the treatments provided at our institution were appropriate and in agreement with the AUC recommendations. Additionally, the AUC had a web-based application that was easy to use and simple for identifying treatment recommendations. LEVEL OF EVIDENCE Retrospective study, level IV.

中文翻译：

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AAOS适当使用标准（AUC）在临床实践中用于膝部骨关节炎的外科手术治疗的可用性。

目的美国骨科医师学会（AAOS）制定了用于膝关节骨关节炎手术治疗的适当使用标准（AUC），以指导外科医生选择最循证的外科手术方案。这项研究旨在通过比较我们机构提供的实际手术治疗与AUC推荐的手术治疗来评估AUC的可用性。方法回顾性分析2017年1月至12月间在我院接受膝骨关节炎（OA）手术的所有患者的病历和X线照片。数据包括每个患者的年龄，性别，疼痛程度，机械症状，活动范围（ROM）和不稳定性，影像学检查的模式和严重程度，肢体对齐以及接受的外科手术类型。收集的数据输入到AUC应用程序中，以确定治疗的适当率。之后，评估了所提供的实际治疗方法与AUC建议之间的一致性。结果纳入连续100例患者。平均年龄为63.1岁，大多数患者年龄（73％）在50至69岁之间。大多数患者为女性（74％），其中61％患有左膝骨关节炎。最常见的患者类型是中年患者，近距离功能受限疼痛，无机械症状或功能不稳，伴有完整ROM，严重的膝关节多室放射学特征，以及内翻或外翻错位。在100例患者中，有85例患者进行了全膝关节置换术（TKA），11例行单室膝关节置换术（UKA），四例行高位胫骨截骨术（HTO）。根据AUC，有90例（90％）病例接受了适当的手术治疗，而10例（10％）病例得到了适当的治疗。在我们医院进行的实际外科手术治疗与AUC建议相符，分别为100％的TKA病例，90.9％的UKA病例和100％的HTO病例。因此，在所有手术病例中，与AUC的一致率为99％。结论这项研究表明，用于膝骨关节炎手术治疗的AUC可以在临床环境中轻松应用。我们机构提供的大多数治疗方法都是适当的，并符合AUC的建议。另外，AUC有一个基于Web的应用程序，该应用程序易于使用且易于识别治疗建议。证据级别回顾性研究，IV级。