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Glossary
Total Knee Replacement Conference
Webcast
(live link)
(Requires RealPlayer
software, which can be
downloaded free of charge from NIH
Videocasting.)
Day
1 (archive 12/8/2003)
Day
2 (archive 12/9/2003)
Day
3 (archive 12/10/2003)
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NIH Consensus and
State-of-the-Science Statements are prepared by
independent panels of health professionals and
public representatives, based on (1) the results of
a systematic literature review prepared under
contract with the Agency for Healthcare Research
and Quality (AHRQ), (2) presentations by
investigators working in areas relevant to the
conference questions during a 2-day public session;
(3) questions and statements from conference
attendees during open discussion periods that are
part of the public session; and (4) closed
deliberations by the panel during the remainder of
the second day and morning of the third. This
statement is an independent report of the panel and
is not a policy statement of the NIH or the Federal
Government.
The statement
reflects the panel's assessment of medical
knowledge available at the time the statement was
written. Thus, it provides a "snapshot in time" of
the state of knowledge on the conference topic.
When reading the statement, keep in mind that new
knowledge is inevitably accumulating through
medical research.
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Background
Total knee replacement (TKR) has shown
increasing success in relieving knee pain and
improving joint function for patients suffering
from knee problems due to injury, degenerative
disease, and inflammation. Each year, approximately
300,000 TKR surgeries are performed in the United
States for end-stage arthritis of the knee joint.
As the number of TKR surgeries performed each year
increases and the indications for TKR extend to
younger patients, a review of available scientific
information is necessary to enhance clinical
decisionmaking and stimulate further research.
First used in the late 1950's, early TKR
implants poorly mimicked the natural motion of the
knee and resulted in high failure and complication
rates. Advances in TKR technology within the past
10 years have enhanced the design and fit of knee
implants, resulting in improved short-term and
long-term outcomes.
Despite the increased success of TKR, questions
remain concerning which materials and implant
designs are most effective for specific patient
populations and which surgical approach is optimal
for a successful outcome. Physical, social, and
psychological issues may influence the success of
TKR, and understanding patient differences could
facilitate the decisionmaking process before,
during, and after surgery, thereby achieving the
greatest benefit from TKR. Particular attention
also must be given to the treatment and timing
options related to the revision of failed TKR
surgery.
Conference Process
To address these questions, the National
Institute of Arthritis and Musculoskeletal and Skin
Diseases and the National Institutes of Health
Office of Medical Applications of Research are
sponsoring a consensus development conference to
explore and assess the current scientific knowledge
regarding TKR. Specifically, the conference will
address the following key questions:
- What are the current indications and
outcomes for primary TKR?
- How do specific characteristics of the
patient, material and design of the prosthesis,
and surgical factors affect the short-term and
long-term outcomes of primary TKR?
- Are there important perioperative
interventions that influence outcomes?
- What are the indications, approaches, and
outcomes for revision TKR?
- What factors explain disparities in the
utilization of TKR in different populations?
- What are the directions for future
research?
During the first 1 1/2 days of the conference,
experts will present the latest TKR research
findings to an independent panel. After weighing
all of the scientific evidence, the panel will
prepare a consensus statement answering the
questions above. On the final day of the
conference, the panel chairperson will read the
draft statement to the conference audience, and
invite comments and questions. A press conference
will follow, that afternoon, to allow the panel to
respond to questions from the media.
Conference Sponsors
Office
of Medical Applications of Research, NIH
National
Institute of Arthritis and Musculoskeletal and Skin
Diseases, NIAMS
Cosponsors
National
Institute of Child Health and Human
Development, NICHD
U.S.
Food and Drug Administration, FDA
National
Institute of Standards and Technology, NIST
Office
of Research on Women's Health, NIH
Partners
National
Library of Medicine, NLM
Agency
for Healthcare Research and Quality, AHRQ
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