BackgroundA patient’s decision-making process to undergo surgery is crucial for surgeons to understand for patient counseling purposes. Total knee and hip arthroplasty, like any other major surgery, is associated with serious, sometimes life-threatening, complications. Using the results of discrete choice experiments (DCE), we aimed to understand the relationship between a patient’s risk tolerance and choosing to undergo surgery in real life. MethodsThis is a retrospective study of prospectively collected DCE results for 142 potential knee or hip arthroplasty clinic patients from October 2021 to March 2022. The DCE presented the patient with two scenarios, each of which was made up of different combinations of attributes and levels. A hierarchal Bayesian model was utilized to obtain a risk score that reflected the risk attributes chosen by each patient. Logistic regressions were then utilized to evaluate the association between a patient’s willingness to incur risk and their decision to undergo a total joint arthroplasty (TJA). ResultsOut of the 142 patients enrolled in the DCE, 89 (62.3%) underwent a TJA. Risk score (OR [odds ratio] = 2.6, 95% CI [confidence interval] 1.1 to 6.6, P = 0.0400), men (OR = 2.5, 95% CI 1.1 to 5.9, P = 0.0280), and patients who have hip osteoarthritis (OR = 2.4, 95% CI 1.1 to 5.5, P = 0.0360) increased the odds of undergoing arthroplasty, whereas physical function of at least 75% at the initial visit (OR = 0.3, 95% CI 0.1 to 0.7, P = 0.0040) decreased these odds. ConclusionsWe found that a patient’s willingness to incur risk, lower baseline physical function, and men were all independently associated with undergoing total knee arthroplasty. We believe that these findings prompt much-needed future studies that focus solely on the relationship between patients inherent risk behavior and surgical and patient-reported outcomes.