Background/Purpose:

Patients’ preferences for total knee replacement (TKR) may determine actual receipt of TKR and may also change over time.  Yet, no study has longitudinally evaluated the treatment preferences regarding joint replacement of patients with knee osteoarthritis (OA).  Our objectives were to evaluate the consistency of patients’ preferences for TKR with receipt of TKR surgery, and to assess patient characteristics that may influence change in willingness to undergo TKR over 2 years.

Methods:

Structured interviews were conducted to determine the socio-demographic data, clinical characteristics, and treatment preferences (i.e. willingness to undergo TKR) of patients with knee OA.  Willingness was measured using a Likert scale ranging from -2 (definitely not willing) to +2 (definitely willing).  Consultation with an orthopedic surgeon and receipt of TKR surgery were ascertained by medical record reviews and structured interviews at 6 months and at 2 years.  Logistic regression models were conducted to assess the association between willingness and consultation with an orthopedic surgeon (or receipt of TKR), adjusted for age, sex, race, education, recruitment site, income, insurance, social support, and baseline WOMAC score.  Mixed models for repeated measures were used to estimate the effects of age, sex, race, social support, change in WOMAC subscale scores, and orthopedic surgical consult on change in willingness over 2 years.

Results:

At baseline, 589 were willing, and 215 were unsure or not willing to undergo TKR surgery.  Willing participants, compared to those who were unwilling, were more often White (69.4% vs. 48.4%), with more than a high school education (60.8% vs. 47.0%), employed (39.1% vs. 26.5%), and had a lower WOMAC total score (46.05 ± 16.12 vs. 50.37 ± 15.42).  At 2-year follow-up, baseline willingness was not associated with having seen an orthopedic surgeon (adjusted OR 0.89, 95% CI [0.62, 1.29]) after adjustment for sociodemographic and clinical variables.   The odds of having TKR was twice as high among those who were willing to have the procedure at baseline, compared to all others, but this was not a statistically significant difference (adjusted OR 2.04, 95% CI [0.92, 4.53]).  

There was a general decline in willingness to undergo TKR over the follow-up period.  Among those who were willing to undergo TKR at baseline, only 66.5% were still willing 2 years later.  This decline in willingness was less among those who had a greater increase (> median) in WOMAC disability scores (adjusted Δ -0.34, 95% CI [-0.47, -0.20]) than those who had minimal change (≤ median) in their WOMAC disability scores (adjusted Δ -0.51, 95% CI [-0.64, -0.37]) (p=0.08).  The decline in willingness was also less among those who had seen an orthopedic surgeon (adjusted Δ -0.32, 95% CI [-0.46, -0.17]) than those who did not during the study period (adjusted Δ -0.51, 95% CI [-0.63, -0.38]) (p=0.05).  Other patient characteristics did not influence changes in willingness.

Conclusion:

Patients’ preferences for TKR were not consistent with utilization of TKR surgery over two years of follow-up.  Willingness to undergo TKR declined over time, but this decrease was mitigated by worsening OA-related disability and by consultation with an orthopedic surgeon.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-preferences-for-total-knee-replacement-surgery-two-year-follow-up/