Patient Factors Affecting Surgeon Selection and the Decision to Delay Total Knee Arthroplasty


  • Keith Berend Joint Implant Surgeons, Inc.
  • Ruizhi Zhao Graduate Studies in Social and Administrative Pharmacy University of Minnesota
  • Angeline Carlson Data Intelligence Consultants, LLC
  • Mark Stultz SPR Therapeutics, LLC



knee arthroplasty, TKA, surgical delay, post-operative pain management, non-opiate, surgeon choice


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.


Author Biographies

Keith Berend, Joint Implant Surgeons, Inc.

Orthopedic Surgeon

Mark Stultz, SPR Therapeutics, LLC

Senior Vice President, Market Development


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How to Cite

Berend, K., Zhao, R., Carlson, A., & Stultz, M. (2017). Patient Factors Affecting Surgeon Selection and the Decision to Delay Total Knee Arthroplasty. Reconstructive Review, 7(2).




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