title: The Choice Between Total Hip Arthroplasty and Arthrodesis in Adolescent Patients: A Survey of Orthopedic Surgeons.
abstract: For adolescent patients with end-stage hip disease, the choice between total hip arthroplasty (THA) and arthrodesis is complex; the clinical evidence is not definitive, and there are difficult trade-offs between clear short-term benefits from THA and uncertain long-term risks. We surveyed nearly 700 members of the Pediatric Orthopedic Society of North America and the American Association of Hip and Knee Surgeons. Respondents chose between a recommendation of THA or arthrodesis in four clinical vignettes. A clear majority of surgeons recommended THA in two of the vignettes, however opinion was somewhat divided in one vignette (overweight adolescent) and deeply divided in another (adolescent destined for manual labor job). Across all vignettes, recommendations varied systematically according to surgeons' age and their attitudes regarding tradeoffs between life stages.
authors: Stanford Law School, Stanford, California.
authors: Mark G
authors: MG
authors: Kelman
authors: Stanford Law School, Stanford, California; Center for Health Policy/PCOR, Stanford University School of Medicine, Stanford, California.
authors: David M
authors: DM
authors: Studdert
authors: Department of Orthopedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, Iowa.
authors: John J
authors: JJ
authors: Callaghan
authors: Center for Health Policy/PCOR, Stanford University School of Medicine, Stanford, California.
authors: Monica S
authors: MS
authors: Farid
authors: Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Ashley L
authors: AL
authors: Titan
authors: Department of Orthopedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, Iowa.
authors: Frederick R
authors: FR
authors: Dietz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000706:statistics & numerical data*; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D009985:Orthopedics / Q000379:methods*; D050177:Overweight; D010818:Practice Patterns, Physicians'; D012955:Societies, Medical; D066231:Surgeons; D011795:Surveys and Questionnaires
keywords: adolescents; arthrodesis; clinical decision making; ethics; survey; total hip arthroplasty