Decision making for knee replacement: variation in treatment choice for late stage medial compartment osteoarthritis.
BACKGROUND
Patients with medial unicompartmental osteoarthritic disease of the knee requiring arthroplasty can be treated with either Total or Unicompartmental Knee Replacement (TKR or UKR). Currently, the decision to choose one operation over another is not well defined and may depend on the profile of the surgeon consulted. We tested the hypothesis that different surgeons will select different treatment for identical patients requiring knee replacement.


METHODS
Four different surgeons, representing four different levels of expertise, made a forced choice decision of whether they would perform TKR or UKR based on radiographs alone and subsequent additional clinical information including gender and age, in 140 patients. Individual surgeon repeatability was tested by repeat assessment 3 months later.


RESULTS
The knee surgeon from the UKR design centre would have performed a UKR in up to 88% of the patients. The remaining surgeons would have performed UKR in 29-48% of patients; a variation in decision making of up to 59%. Additional clinical information had little effect on decision making with surgeons maintaining their radiographic based choice in 80 to 87% of cases. The repeatability study showed high within surgeon consistency for treatment choice.


CONCLUSIONS
Surgeons, given identical information, do not concur on treatment for patients with the same pathology. The decision making process appears heavily influenced by radiographic findings but individual surgeons are consistent with their own treatment choice. The study shows that consensus treatment for medial osteoarthritis of the knee remains in question.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK. david.beard@ndorms.ox.ac.uk
D J
DJ
Beard
M D
MD
Holt
M M
MM
Mullins
S
S
Malek
E
E
Massa
A J
AJ
Price
D000328:Adult; D019645:Arthroplasty, Replacement, Knee; D002983:Clinical Competence; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D009985:Orthopedics; D020370:Osteoarthritis, Knee / Q000601:surgery*; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011474:Prosthesis Design