Patient Preferences When Selecting Their Total Joint Arthroplasty Surgeon: A Multicenter Survey Study

Abstract

Background: Surgeon selection can influence patient satisfaction, outcomes, and access in total joint arthroplasty (TJA). Awareness of patient preferences enables practices to enhance trust, optimize communication, and improve adherence. While referrals and word-of-mouth recommendations often outweigh online marketing, prospective multicenter research exploring how patients choose their TJA surgeon is limited. The aim of this study was to identify key decision-making factors and how they vary by demographics.

Methods: This prospective, multicenter cross-sectional survey study included patients undergoing elective total joint arthroplasty at 4 high-volume institutions from January 2024 to 2025. Participants completed a survey on surgeon selection, including how they first heard of the surgeon, number of visits before deciding on surgery, and whether other surgeons were consulted. Patients rated 10 factors (1-10 scale) and selected the top 3 most important ones from a list of 7 factors.

Results: Among 808 participants, most selected their surgeon through referrals (44.9%) or word-of-mouth recommendations (18.7%); only 8.4% cited online advertisements. Female patients rated surgeon gender (p = 0.010), ease of communication (p = 0.036), and time spent (P = 0.008) as more important than male patients. Minority patients prioritized gender (p = 0.003), race (p < 0.001), bedside manners (p = 0.013), time spent (p = 0.045), and implant type used (p = 0.004) more than White patients. Patients with a median household income between $30,000 and $70,000 rated insurance acceptance higher than those with household income higher than $300,000 (p = 0.007).

Conclusions: Patients choose their arthroplasty surgeon primarily by way of referrals and word-of-mouth recommendations, underscoring the importance of trust. Female and minority patients value surgeon gender, race, and interpersonal skills, supporting culturally responsive care. Strengthening primary care physician engagement and community outreach may improve trust and promote equitable access.