Which disease-related factors influence patients\u2019 and physicians\u2019 willingness to consider joint replacement in hip and knee OA? Results of a questionnaire survey linked to claims data

Anne Postler,Imke Redeker,Jens Goronzy,Toni Lange,Angela Zink,Klaus-Peter Günther,Jochen Schmitt,Johanna Callhoff

doi:10.1186/s12891-020-03368-1

Abstract

BackgroundA great heterogeneity in total joint replacement (TJR) rates has been reported for osteoarthritis (OA), most likely arising from a gap between patients’ and physicians’ views on the need for TJR. The purpose of this study therefore was to analyze potential cofactors which might influence the desire of patients to undergo TJR and physicians’ willingness to discuss surgery with their patients.MethodsA total of 8995 patients in Germany with a claims data diagnosis of hip or knee OA or polyarthrosis were asked to complete a questionnaire for this cross-sectional study of sociodemographic factors, indicators of current joint function (WOMAC score), willingness to undergo TJR and whether they had already discussed TJR with a physician. The overall response rate was 40%. Responders with polyarthrosis and individuals without current or chronic symptoms in the corresponding joints, pain in already replaced joints or simultaneous symptomatic hip and knee OA were excluded. We linked the survey results to claims data. Separate logistic regression models were used to assess which parameters were associated with patients’ willingness to undergo TJR and physicians’ discussion of surgery.ResultsWe analyzed 478 hip OA and 932 knee OA patients. Just 17% with hip OA and 14% with knee OA were willing to undergo TJR, although 44 and 45% had already discussed surgery with their physicians.Patients’ willingness was associated with higher WOMAC scores, a deterioration of symptoms over the last 2 years, and previous TJR for another joint. The discussion with a physician was influenced by the impact on personal life and previous arthroplasty. Older age (odds Ratio (OR) 1.2 per 10 years), male sex (OR 0.69 vs female), longer symptom duration (OR 1.08 per 5 years), deterioration of symptoms (OR 2.0 vs no change/improvement), a higher WOMAC score (OR 1.3 per 10% deterioration) and reduced well-being (OR 1.1 per 10% deterioration) were associated with physician discussion in knee OA patients.ConclusionsThe proportion of patients willing to undergo TJR is lower than the proportion in whom physicians discuss surgery. While previous TJR seems to enhance patients’ and surgeons’ willingness, the influence of other cofactors is heterogeneous.

Highlights

A great heterogeneity in total joint replacement (TJR) rates has been reported for osteoarthritis (OA), most likely arising from a gap between patients’ and physicians’ views on the need for TJR
The proportion of patients willing to undergo TJR is lower than the proportion in whom physicians discuss surgery
Mean age was years (95% confidence interval (CI) 63–65) in the group with hip OA and years in the group with knee OA

Summary

Introduction

A great heterogeneity in total joint replacement (TJR) rates has been reported for osteoarthritis (OA), most likely arising from a gap between patients’ and physicians’ views on the need for TJR. Half of the world’s population aged 65 and older suffers from some form of OA [1]. It is one of the most common sources of pain and disability in the elderly [1,2,3], and international reports indicate that the prevalence of OA is on the rise [4]. Pain, loss of function and radiological changes are generally considered in the decision to perform total hip replacement (THR) or total knee replacement (TKR) [9, 10]. There is great variation both in indications for surgery among orthopaedic surgeons [11, 12] and in the utilization of arthroplasty in general [13]

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