Patient Factors Affecting Surgeon Selection and the Decision to Delay Total Knee Arthroplasty
DOI:
https://doi.org/10.15438/rr.7.2.176Keywords:
knee arthroplasty, TKA, surgical delay, post-operative pain management, non-opiate, surgeon choiceAbstract
Background: Delaying total knee arthroplasty (TKA) carries an increased likelihood of poor rehabilitation outcomes. Reasons behind choosing to delay surgery are under investigated. This study explores potential factors related to the decision to delay a TKA procedure and preferences for post-surgical pain management.
Methods: A cross-sectional online survey was conducted among TKA candidates in the US.
Results: 6,298 persons received a screening questionnaire; 2,571 (41%) completed screening with 680 (26%) meeting survey eligibility criteria. 654 of 680 persons (96%) completed surveys. 154 (24%) respondents had delayed TKA. Interference with work and concerns about insufficient post-discharge pain management were found to be significant factors in this decision. A one unit increase in the ten point interference with work scale was associated with a 22% increase in the odds of delaying surgery (OR: 1.219; 95%CI: 1.095-1.356). Surgical candidates concerned about experiencing pain during the first several weeks following surgery had significantly higher odds of delaying surgery (OR: 1.64, 95% CI: 0.881-3.06). Ninety-two percent of respondents indicated they would seek surgeons who offered effective non-opiate pain management options during the first several weeks of the rehabilitation period; 66 percent indicated they would likely switch surgeons for access to a non-opioid pain management approach.
Conclusions: Delaying a TKA is significantly influenced by concerns about interference with work and experiencing an extended period of post-surgical pain during a potentially prolonged recovery period. Access to postoperative pain management methods that reduce or eliminate opioid use during post-discharge rehabilitation and recovery is an important factor in the selection of a joint replacement surgeon.
References
Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, Beard DJ. Knee replacement. 2012. Lancet 379: 1331-1340.
Kurtz SM, Ong KL, Lau E, Bozic KJ. Impact of the economic downturn on total joint replacement demand in the United States: Updated projections to 2021. 2014. Journal of Bone and Joint Surgery 96-A (8): 624-630.
Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: National projections from 2010 to 2030. 2009. Clinical Orthopedic Related Research 467: 2606-2612.
Hassett G, Hart DJ, Doyle DV, March L, Spector TD. 2006. The relation between progressive osteoarthritis of the knee and long term progression of osteoarthritis of the hand, hip, and lumbar spine. Ann Rheum Dis 65:623–628
Arendt EA, Miller LE, Block JE. Early knee osteoarthritis management should first address mechanical joint overload. 2014. Orthopedic Reviews 6: 5188.
London NJ, Miller LE, Block JE. Clinical and economic consequences of the treatment gap in knee osteoarthritis management. 2011. Medical Hypotheses 76: 887-892.
Andersen LO, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS. Subacute pain and function after fast-track hip and knee arthroplasty. 2009. Anaesthesia 64: 508-513.
Carroll I, Barelka P, Wang CKM, Wang BM, Gillespie MJ, McCue R, Younger JW, Trafton J, Humphreys K, Goodman SB, Dirbas F, Whyte RI, Donington JS, Cannon WB, Mackey SC. 2012. A pilot cohort study of the determinants of longitudinal opioid use after surgery. Anesthesia and Analgesia 115 (3): 694-702.
National Institutes of Health Consensus Panel. NIH consensus statement on total knee replacement December 8-10, 2003. Journal of Bone and Joint Surgery 86-A (6): 1328-1335.
Passik SD, Hays L, Eisner N, Kirsh KL. Psychiatric and pain characteristics of prescription drug abusers entering drug rehabilitation. 2006. J Pain Palliat Care Pharmacother 20:5–13
Potter JS, Hennessy G, Borrow JA, Greenfield SF, Weiss RD. Substance use histories in patients seeking treatment for controlled-release oxycodone dependence. 2004. Drug Alcohol Depend 76:213–215.
Hays L, Kirsh KL, Passik SD. Seeking drug treatment for OxyContin abuse: a chart review of consecutive admissions to a substance abuse treatment facility in Kentucky. 2003. J Natl Compr Canc Netw 1:423–428.
Solomon DH, Rassen JA, Glynn RJ, Lee J, Levin R, Schneeweiss S. The Comparative Safety of Analgesics in Older Adults With Arthritis Arch Intern Med. 2010;170 (22):1968-1978.
Ibrahim SA, Siminoff L, Burant CJ, Kwoh CK. 2002. Understanding ethnic differences in the utilization of joint replacement for osteoarthritis: the role of patient-level factors. Medical Care 40 (1 Suppl): 44–51.
Suarez-Almazor ME, Soucheck J, Kelly A, O'Malley KM, Byrne MM, Richardson MM, et al. Ethnic variation in knee replacement: patient preferences or uninformed disparity? 2005. Arch Intern Medicine 165:1–8
SurveyMonkey®. https://www.surveymonkey.com/mp/audience/our-survey-respondents/
Ilfeld BM. Informed consent for medical research: An ethical imperative. 2006. Reg Anesth Pain Med 31: 353–7.
Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. 1994. Ann Acad Med Singapore 23 (2): 129-138.
Kapstad H, Hanestad BR, Langeland N, Rustoen T, Stavem K. Cutpoints for mild, moderate and severe pain in patients with osteoarthritis of the hip or knee ready for joint replacement surgery. 2008. BMC Musculoskeletal Disorders 9:55 doi:10.1186/1471-2474-9-55
Jensen MP, Smith DG, Ehde DM, Robinsin LR. Pain site and the effects of amputation pain: further clarification of the meaning of mild, moderate and severe pain. 2001. Pain 91: 317-322.
Pearson K, Heron D. On theories of association. 1913. Biometrika 9(1/2): 159-315.
Cox, DR. The regression analysis of binary sequences. 1958. Journal of the Royal Statistical Society. Series B (Methodological): 215-242.
SAS Institute. (2012). SAS/STAT 12.1 User's Guide Survival Analysis (book Excerpt). SAS Institute Incorporated.
Scott CEH, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: A prospective study of 1217 patients. 2010. Journal of Bone and Joint Surgery 92-B (9): 1253-1258.
Chan EY, Blyth FM, Nairn L, Fransen M. Acute postoperative pain following hospital discharge after total knee arthroplasty. 2013. Osteoarthritis and Cartilage 21: 1257-1263.
Franklin PD, et al. Reduction in narcotic use after primary total knee arthroplasty and association with patient pain relief and satisfaction. J Arthroplasty. 2010; 25 (6, Supp 1): 12-16.
Zywiel MG, et al. Chronic opioid use prior to total knee arthroplasty. 2011. J Bone Joint Surg Am 93; 1988-93.
Crane JH, Suda KJ. Oxycodone induced delirium and agitation in an elderly patient following total right knee arthroplasty. 2011. Int J Clin Pharm. 33:733–736
Patanwala AE et al. Comparison of opioid requirements and analgesic response in opioid-tolerant versus opioid-naïve patients after total knee arthroplasty. Pharmacotherapy. 2008; 28 (12): 1453-60.
FDA. Available at http://www.fda.gov/forconsumers/consumerupdates/ucm336581.htm
Published
How to Cite
Issue
Section
License
Copyright (c) 2017 Keith Berend, Ruizhi Zhao, Angeline Carlson, Mark Stultz
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
