title: Opportunities in Total Knee Arthroplasty: Worldwide Surgeons' Perspective.
abstract: BACKGROUND
  This study surveyed a group of US and international orthopaedic surgeons to prioritize areas of improvement in primary total knee arthroplasty (TKA). Specifically, we assessed surgeon responses regarding the top five areas of TKA needing improvement; which were stratified by: a) US surgeons, b) international surgeons, c) US surgeons' implant-brand-loyalty, and d) surgeons' years of experience and case volume.
  
  
  METHODS
  Four hundred and eighteen surgeons who were board-certified, in practice for at least two years, spent 60% of their time in clinical practice, and performed a minimum of 25 lower extremity joint arthroplasties per year were surveyed. They chose the top five areas (among 17) needing improvement for TKA. Results were stratified by surgeons' location (US and international), implant-brand-loyalty, years of experience, and case volume.
  
  
  RESULTS
  Functional outcomes was the top identified area for improvement (US 63% and international 71%), followed by brand loyalty (Company I 68%, other brand 59%, and multi-brand/no loyalty 66%), years of experience (early-career 64%, mid-career 63%, and late-career 75%) and case volume (low-volume 69%, mid-volume 60%, and high-volume 71%). Following this was costs for US surgeons (47%) and implant survivorship for international surgeons (57%). While costs were the next highest area for specific Company-loyal surgeons (57%), implant survivorship was the next highest area for the other two cohorts. Implant survivorship was the second most important area of improvement regardless of years of experience and for low- and mid-volume surgeons.
  
  
  CONCLUSIONS
  Surgeons identified functional outcomes as the most important area needing improvement. Cost of implants was more important for American as compared to international surgeons.
authors.affiliation: Division of Orthopaedic Surgery, Dalhousie University, Nova Scotia, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Dunbar
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Newman
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anton
authors.initials: A
authors.lastname: Khlopas
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Stryker Orthopaedics, Mahwah, New Jersey.
authors.forename: Nick
authors.initials: N
authors.lastname: Martinez
authors.affiliation: Stryker Orthopaedics, Mahwah, New Jersey.
authors.forename: Manoshi
authors.initials: M
authors.lastname: Bhowmik-Stoker
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D019981:Health Care Sector; D006801:Humans; D007720:Knee Prosthesis; D066231:Surgeons / Q000458:organization & administration / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires