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Abstract Number: 1083

Physicians’ Recommendations for Total Knee Arthroplasty in Younger Persons with Moderate Osteoarthritis

Liana Fraenkel1, Lawrence Weis2 and Lisa Suter3, 1Medicine, Section of Rheumatology, Yale University School of Medicine, Veterans Affairs Connecticut Healthcare System, New Haven, CT, 2Medicine, Yale University, New Haven, CT, 3Medicine, Rheumatol, TAC S541, Yale University, New Haven, CT

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Knee, osteoarthritis and total joint replacement

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Session Information

Title: Orthopedics, Low Back Pain, and Rehabilitation

Session Type: Abstract Submissions (ACR)

Background/Purpose: Rates of total knee arthroplasty (TKA) are increasing among all age groups. The most rapidly growing population of patients undergoing TKA are those under the age of 65. This reason for this increasing prevalence is unclear. While physicians’ recommendations regarding use of TKA are likely to be fairly uniform for patients with severe OA, little is known regarding physicians’ decision-making for younger patients with less severe arthritis. The objective of this study was to gain insight into the factors influencing physicians’ recommendations for younger persons with OA using an experimental 2x2x2 design.

Methods: A convenience sample of rheumatologists and orthopedic surgeons, recruited at their respective national meetings, completed a survey including a standardized scenario of a 62 year old person with knee OA who has moderate knee pain limiting strenuous activity despite medical management. The scenarios varied on patient gender, employment status (business manager vs retired), and x-ray (mild vs moderate OA). Each subject rated their recommendation for a single scenario (distributed randomly) on a 7-point scale. Recommendation was treated as a dichotomous variable: For vs Against TKA.

Results: 406 surgeons [mean age (SD) = 49 (10), 18% female] and 494 rheumatologists; [mean age (SD) = 48 (10), 44% female] participated. Overall, 51% of both surgeons and rheumatologists recommended TKA. As expected, both groups recommended TKA more frequently for scenarios including more severe radiographic OA (Table 1). However, this feature had a greater influence among rheumatologists than orthopedic surgeons. Orthopedic surgeons were more likely to recommend TKA for male vs female patients. Whereas, rheumatologists were less likely to recommend referral for TKA for business managers compared to housewives or retired men. The influence of physicians’ demographic characteristics on TKA recommendation is presented in Table 2. Younger physicians, regardless of specialty, were more likely to recommend TKA (p <0.05). Rheumatologist’ recommendations for TKA did not vary by geographic location; however, American and Asian surgeons were more likely to recommend TKA compared to their European counterparts.

Conclusion: Physicians recommendations for TKA vary significantly for younger patients with moderate OA. Recommendations are influenced by both physician and patient characteristics.

Table 1. Influence of Patient Characteristics on Physicians’ Recommendations for TKA

Patient Characteristics

Percent of Rheumatologists Recommending TKA

Percent of Orthopedic Surgeons Recommending TKA

Moderate vs Mild radiographic changes

60 vs 41, p<0.0001

56 vs 47, p=0.05

Male vs Female

49 vs 52, p=0.5

59 vs 44, p=0.002

Working outside of the home  vs Retired / Housewife

42 vs 56, p=0.002

49 vs 53, p=0.4

 

Table 2. Influence of Physician Characteristics on their Recommendations for TKA

Physician Characteristics

Percent of Rheumatologists Recommending TKA

Percent of Orthopedic Surgeons Recommending TKA

Age (<50 vs ≥ 50)

55 vs 46, p=0.03

57 vs 47, p=0.04

Male vs Female

50 vs 53, p=0.5

51 vs 56, p=0.7

Location (Asia vs Europe vs US)

54 vs 49 vs 52, p=0.8

67 vs 34 vs 52, p=0.006


Disclosure:

L. Fraenkel,
None;

L. Weis,
None;

L. Suter,
None.

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