American Academy of Orthopaedic Surgeons Appropriate Use Criteria for Humeral Component Design During Primary Anatomic Total Shoulder Arthroplasty.

The American Academy of Orthopaedic Surgeons (AAOS) has developed appropriate use criteria (AUC) for humeral component design during primary anatomic total shoulder arthroplasty. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to determine the appropriateness of various humeral component designs during primary anatomic total shoulder arthroplasty. The AUC for humeral component design during primary anatomic total shoulder arthroplasty w ere derived by identifying clinical indications evident during the clinical decision-making process. These scenarios relied on definitions and general assumptions, mutually agreed on 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 rating the scenarios and readers using the final criteria. Writing panel members of this AUC developed patient scenarios using these guiding principles: comprehensive (covers a wide range of patients); mutually exclusive (there should be no overlap between patient scenarios/indications); homogeneous (the final ratings should result in equal application within each of the patient scenarios); and manageable (number of total rating items [ie, number of patient scenarios × number of treatments] should be practical for the rating panel). The target number of total rating items is 1,500. This means that not all patient indications and treatments can be assessed within the AUC. The 144 patient scenarios and three treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, rating panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as 'appropriate' (median rating, 7 to 9), 'may be appropriate' (median rating, 4 to 6), or 'rarely appropriate' (median rating, 1 to 3).