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AAOS Now

Published 3/1/2013

CPGs In Development

The AAOS Clinical Practice Guidelines (CPG) unit is currently working on the following CPGs:

  • Treatment of Osteoarthritis of the Knee (OAK)
  • Early Detection and Management of Pediatric Developmental Dysplasia of the Hip (DDH)
  • Management of Hip Fractures in Elderly Patients (Hip Fx)
  • Anterior Cruciate Ligament Injuries (ACL)
  • Surgical Management of Osteoarthritis of the Knee (SMOAK)

CPGs are developed using a rigorous, standardized process, corresponding to the Institute of Medicine (IOM) standards, and involve the assessment of the current scientific literature and clinical information along with accepted approaches to treatment. The CPG process from beginning (selecting topic and soliciting for work group members) to end (approval by the AAOS Board of Directors) takes approximately 18 to 24 months, depending on factors such as the amount of research available to appraise and include.

CPG on OAK
The work group members for the OAK (nonsurgical) CPG developed rationales and graded the recommendations based on their review of the available evidence in fall 2012. During the peer review process, representatives from 15 specialty organizations participated. A complete list follows.

OAK CPG Peer-Review Organizations

  • American Academy of Family Physicians (AAFP)
  • American Academy of Physical Medicine and Rehabilitation (AAPMR)
  • American Association of Hip and Knee Surgeons (AAHKS)
  • Arthroscopy Association of North America (AANA)
  • American College of Sports Medicine (ACSM)
  • American Orthopaedic Society for Sports Medicine (AOSSM)
  • American Physical Therapy Association (APTA)
  • Eastern Orthopaedic Association
  • Mid-America Orthopaedic Association
  • Orthopaedic Trauma Association (OTA)
  • Southern Orthopaedic Association
  • The Arthritis Foundation
  • The Knee Society and Western Orthopaedic Association

The work group considered all of the input received from the peer review and made final revisions in January 2013 before sending the CPG out for its 30-day Public Comment period (February–March 2013). The OAK CPG will then be finalized and the approval process will begin. The OAK CPG is expected to be presented to the AAOS Board of Directors for final approval during its May 2013 meeting.

CPG on DDH
The work group members for the DDH CPG have formulated questions and set inclusion criteria for the literature review. An AAOS staff research analyst is in the process of appraising the strength of the studies.

The DDH CPG work group includes representatives from seven specialty organizations. A complete list follows.

DDH CPG Work Group Member Organizations

  • AAFP
  • American Academy of Pediatrics
  • American College of Radiology
  • American Institute of Ultrasound in Medicine
  • Society of Diagnostic Medical Sonography
  • Society for Pediatric Radiology
  • Pediatric Orthopaedic Society of North America

Following approval of the included literature, the DDH CPG work group will reconvene at a final meeting, to be scheduled for this spring, to construct final recommendations and assign a grade for each based on the best available evidence.

CPG on Hip Fx
The work group members for the Hip Fx CPG have formulated questions and set inclusion criteria for the review of the literature. An AAOS staff research analyst is in the process of appraising the strength of the studies. Fifteen specialty organizations are represented on the Hip Fx CPG work group; a complete list follows.

Hip Fx CPG Work Group Member Organizations

  • AAFP
  • AAPMR
  • AAOS & US Bone and Joint Decade
  • American Association of Clinical Endocrinologists
  • AAHKS
  • American College of Emergency Physicians
  • American Osteopathic Academy of Orthopaedics/ American Osteopathic Association
  • American Society of Anesthesiologists
  • American Society for Bone and Mineral Research
  • The American Geriatrics Society
  • The Endocrine Society
  • The Hip Society
  • National Osteoporosis Foundation
  • Orthopaedic Rehabilitation Association
  • OTA

Following the approval of the appropriate literature, the Hip Fx CPG work group will reconvene at a final meeting, to be scheduled for later this year, to construct final recommendations and assign a grade and rating for each based on the available evidence.

CPG on ACL
The work group members for the ACL CPG have formulated questions and set inclusion criteria for the review of the literature, and an AAOS staff research analyst is in the process of completing the literature review and evaluating study strengths. The ACL CPG work group includes representatives from eight specialty organizations; a complete list follows.

ACL CPG Work Group Member Organizations

  • AAPMR
  • ACSM
  • American Medical Society for Sports Medicine
  • AOSSM
  • APTA
  • AANA
  • The National Academy of Sports Medicine
  • The National Athletic Trainer’s Association

Following the approval of the appropriate literature, the ACL CPG work group will reconvene at the final meeting, to be scheduled later this year, to construct final recommendations and assign a grade to each based on the available evidence.

CPG on SMOAK
Solicitation for work group members for the SMOAK CPG has been completed. Orthopaedic specialty societies and other medical societies have nominated individuals to submit applications for the work group. Full disclosure of any potential conflicts of interest for each applicant is required, and the AAOS Committee on Outside Interests determines whether applicants meet the eligibility requirements specified in the Guidance Document on CPG Work Groups. A review of applications is being conducted and the work group member appointments are in progress.

A pilot survey to seek input from patients and/or those who have cared for a family member or friend who underwent the surgical treatment for knee osteoarthritis will be tested during the development of this CPG. Involving patients is one of the standards for guideline development according to the Institute of Medicine.

More on the AAOS-ADA CPG
The AAOS CPG Unit collaborated with the American Dental Association (ADA) to develop the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures CPG, which was approved in December 2012. The full guideline and supplementary materials can be found on the AAOS website at
www.aaos.org/guidelines

AAOS Now published an article and an online extra interview with David Jevsevar, MD, MBA, about the CPG, which can be found at www.aaosnow.org (January 2013 issue).

This month’s Journal of the AAOS (JAAOS) includes the CPG summary of recommendations, two guest commentaries, and the shared decision making tool document. All can be accessed through the OrthoPortal (www.orthoportal.org) and on the JAAOS website, www.jaaos.org

An April issue of The Journal of Bone and Joint Surgery (www.jbjs.org) will include the CPG summary of recommendations with links to the full guideline document and its supplementary materials.

The AAOS-ADA guideline summary has also been submitted to the National Guideline Clearinghouse and the Guidelines International Network online library databases.