Perspectives of orthopaedic surgeons on patients' appropriateness for total joint arthroplasty: a qualitative study.
OBJECTIVE
As total joint arthroplasty (TJA) rates rise, there is need to ensure appropriate use. Our objective was to elucidate surgeons' perspectives on appropriateness for TJA.


METHODS
Semi-structured telephone interviews were conducted in a sample of orthopaedic surgeons that perform TJA in three Canadian Provinces. Surgeons were asked to discuss their criteria for TJA appropriateness for osteoarthritis; potential value of a decision-support tool to select appropriate candidates; and the role of other stakeholders in assessing appropriateness.


RESULTS
Of 17 surgeons approached for participation, 14 completed interviews (12 males; 7 aged <50 years; 5 academic; 8 in urban practices). Surgeons agreed that pain and pain impact on patients' quality of life and function were the key criteria to assess appropriateness for TJA, but that these concepts were difficult to assess and not always congruent with structural changes on joint radiography. Some used a wider range of criteria, including their assessments of patient expectations, ability to cope and readiness for surgery. While patient age was not identified as a criterion itself, surgeons did acknowledge that appropriateness criteria may differ for younger versus older patients. Most agreed that a decision-support tool would help ensure that all elements of appropriateness are assessed in a standardized manner, albeit the ultimate decision to offer surgery must be left to the discretion of surgeons, within the context of the doctor-patient relationship.


CONCLUSIONS
Surgeons recognized the need for a tool to support decision making for TJA, particularly in the context of increasing surgical demand in younger patients with less severe arthritis. The work to develop and test such a decision-support tool is underway.
Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada.
Lucy
L
Frankel
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Claudia
C
Sanmartin
Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada.
Gillian
http://orcid.org/0000-0001-6358-1197
G
Hawker
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Carolyn
C
De Coster
Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Michael
M
Dunbar
Department of Surgery, Concordia Joint Replacement Group, University of Manitoba, Winnipeg, Manitoba, Canada.
Eric
E
Bohm
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Tom
T
Noseworthy
D000223:Adaptation, Psychological; D000367:Age Factors; D000368:Aged; D019643:Arthroplasty, Replacement / Q000523:psychology*; D002170:Canada; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D000072161:Orthopedic Surgeons / Q000523:psychology*; D010003:Osteoarthritis / Q000150:complications / Q000601:surgery*; D010146:Pain / Q000209:etiology; D010817:Physician-Patient Relations; D036301:Qualitative Research; D011788:Quality of Life; D018570:Risk Assessment
appropriateness; patient-centred care; total joint arthroplasty