A qualitative study of impediments to total knee replacement among indians with severe knee osteoarthritis

Abstract

Objective: The objective of this study is to determine the barriers for seeking a total knee replacement (TKR) in Indians with osteoarthritis, despite an increasing need for the surgery. Materials and Methods: Interviews were conducted with 350 Indian patients (109 males, 241 females) who underwent TKR at a tertiary care orthopedic center. The interviews were conducted with each individual based on a questionnaire of 18 questions, which emphasized the patient's reasoning and perceptions regarding TKR. Questions were asked after the patients were admitted but before undergoing TKR. Pain severity and disability before receiving TKR were measured with the Lequesne Index and Oxford Knee Score. Results: Patients requiring TKR were undergoing surgery 13 months after being advised for surgery. Multiple barriers in choosing surgery were identified: (i) wanting to manage pain and disability for as long as possible, (ii) loss of autonomy in making the decision to undergo surgery, (iii) financial issues in affording surgery, (iv) belief that the patients themselves are unfit for surgery and fear of postsurgical complications and morbidity. Conclusions: Despite there being several barriers to the surgical treatment of knee osteoarthritis, physicians must develop strategies to help bridge the gap between patients requiring TKR and the patients electing to undergo the surgery.