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. 2022 Apr;37(4):624-629.e18.
doi: 10.1016/j.arth.2021.12.021. Epub 2021 Dec 21.

Patient and Surgeon Risk-Taking Regarding Total Joint Arthroplasty

Mark Alan Fontana  1 , Cathlyn K Medina  2 , Eleni C Kohilakis  3 , Andrew D Pearle  4 , Catherine H MacLean  5 , Alexander S McLawhorn  6
Affiliations

Patient and Surgeon Risk-Taking Regarding Total Joint Arthroplasty

Mark Alan Fontana et al. J Arthroplasty. 2022 Apr.

Abstract

Background: Decisions regarding care for osteoarthritis involve physicians helping patients understand likely benefits and harms of treatment. Little work has directly compared patient and surgeon risk-taking attitudes, which may help inform strategies for shared decision-making and improve patient satisfaction.

Methods: We surveyed patients contemplating total joint arthroplasty visiting a high-volume specialty hospital regarding general questions about risk-taking, as well as willingness to undergo surgery under hypothetical likelihoods of moderate improvement and complications. We compared responses from surgeons answering similar questions about willingness to recommend surgery.

Results: Altogether 82% (162/197) of patients responded, as did 65% (30/46) of joint replacement surgeons. Mean age among patients was 66.4 years; 58% were female. Surgeons averaged 399 surgeries in 2019. Responses were similar between groups for general, health, career, financial, and sports/leisure risk-taking (P > .20); surgeons were marginally more risk-taking in driving (P = .05). For willingness to have or recommend surgery, as the chance of benefit decreased, or the chance of harm increased, the percentage willing to have or recommend surgery decreased. Between a 70% and 95% chance of moderate improvement (for a 2% complication risk), as well as between a 90% and 95% chance of moderate improvement (for 4% and 6% complication risks), the percentage willing to have or recommend surgery was indistinguishable between patients and surgeons. However, for lower likelihoods of improvement, a higher percentage of patients were willing to undergo surgery than surgeons recommended. Patients were also more often indifferent between complication risks.

Conclusion: Although patients and surgeons were often willing to have or recommend joint replacement surgery at similar rates, they diverged for lower-benefit higher-harm scenarios.

Keywords: complications; expectations; improvement; risk taking; shared decision-making; uncertainty.

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