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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2016

Open Access 01-08-2016 | Knee

The reason why orthopaedic surgeons perform total knee replacement: results of a randomised study using case vignettes

Authors: W. C. Verra, K. Q. Witteveen, A. B. Maier, M. G. J. Gademan, H. M. J. van der Linden, R. G. H. H. Nelissen

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2016

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Abstract

Purpose

End-stage knee osteoarthritis (OA) results in total knee arthroplasty (TKA) surgery. The decision to perform TKA is not well defined, resulting in variation of indications among orthopaedic surgeons. Non-operative treatment measures are often not extensively used. Aim of this study was to investigate factors influencing the decision to perform TKA by Dutch orthopaedic surgeons.

Methods

Three case vignettes, each case divided into two versions, being identical except for information on age (younger and older age), pain (mild and severe pain) or radiological OA (low and high grade) were developed. A questionnaire including these three case vignettes was sent to 599 Dutch orthopaedic surgeons, who were randomised to either one of the two versions. The orthopaedic surgeons were asked whether TKA would be the next step in treatment. Furthermore, from a list of patient factors they were asked how strong these factors would influence the decision to perform TKA.

Results

54 % of the orthopaedic surgeons completed the questionnaire (n = 326). Orthopaedic surgeons indicated to perform TKA significantly more often at higher age (73.3 vs. 45.5 %, p < 0.001). In the presence of mild pain, orthopaedic surgeons were slightly more reluctant to perform a TKA compared to severe pain (57.0 vs. 64.0 %, n.s.). Mild radiological OA made surgeons more reluctant to perform TKA compared to severe OA (9.7 vs. 96.9 %, p < 0.001).

Conclusion

Old age and severe radiological OA are variables which are considered to be important in the decision to perform a TKA. Pain symptoms of moderate or severe pain are unequivocal when considering a TKA.

Level of evidence

Economic/decision analysis, Level III.
Appendix
Available only for authorised users
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Metadata
Title
The reason why orthopaedic surgeons perform total knee replacement: results of a randomised study using case vignettes
Authors
W. C. Verra
K. Q. Witteveen
A. B. Maier
M. G. J. Gademan
H. M. J. van der Linden
R. G. H. H. Nelissen
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3961-5

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