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J Knee Surg 2023; 36(14): 1413-1421
DOI: 10.1055/s-0043-56998
Special Focus Section

Factors Important to Patients when Making Treatment Decisions for Knee Osteoarthritis

Kylee Rucinski 
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Emily Leary 
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Lisa A. Royse 
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Abstract

Patient treatment decisions for knee osteoarthritis (OA) are driven largely by the patient's physical examination and radiograph findings. Because multiple treatment options may be medically appropriate, it is imperative that the patient's voice be considered to better facilitate patient-centered treatment decisions. Concordance between physicians and patients on optimal treatment can vary, with few studies identifying the factors important to patients when making treatment decisions for knee OA. The goal of this analysis is to identify and synthesize subjective factors in the literature found to influence patient decision-making in a presurgical knee OA population, such that physicians and health care teams can become better equipped to help patients realize their specific treatment goals. This review was registered with PROSPERO and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. A systematic search was completed in four databases for search terms related to knee OA and decision-making. Articles were eligible for inclusion when they discussed (1) patients' thoughts, feelings, goals, and perceptions that factored into treatment deliberation and decision-making; and (2) related to knee OA. Twenty-four articles were identified, 11 qualitative studies and 13 quantitative studies. Synthesis of the included articles revealed three main themes that drive patient treatment decisions: (1) individual catalysts to pursue treatment including pain and mobility limitations, (2) interpersonal factors including social networks and clinician trust, and (3) risks versus benefits assessment including patients' beliefs and expectations. Only a few studies looked at nonoperative treatment decisions, and no studies looked at cohorts considering knee preservation surgeries. This study was completed to synthesize literature related to patient treatment decisions for nonoperative and surgical management of knee OA, finding that patients consider multiple subjective factors when choosing whether to move forward with treatment. Understanding how patients' beliefs determine their preferences for treatment can improve shared decision-making.

Keywords

knee osteoarthritis - decision-making - treatment choice - shared decision-making

Supplementary Material



Publication History

Received: 03 January 2023

Accepted: 13 March 2023

Article published online:
18 April 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Lawrence RC, Helmick CG, Arnett FC. et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41 (05) 778-799
    CrossrefPubMedGoogle Scholar
  • 2 Khan M, Adili A, Winemaker M, Bhandari M. Management of osteoarthritis of the knee in younger patients. CMAJ 2018; 190 (03) E72-E79
    CrossrefPubMedGoogle Scholar
  • 3 Huang Y, Liu X, Xu X, Liu J. Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis : a prospective randomized controlled study. Orthopade 2019; 48 (03) 239-247
    CrossrefPubMedGoogle Scholar
  • 4 Messier SP, Mihalko SL, Legault C. et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA 2013; 310 (12) 1263-1273
    CrossrefPubMedGoogle Scholar
  • 5 Rönn K, Reischl N, Gautier E, Jacobi M. Current surgical treatment of knee osteoarthritis. Arthritis (Egypt) 2011; 2011: 454873
    PubMedGoogle Scholar
  • 6 Hunter CW, Deer TR, Jones MR. et al. Consensus guidelines on interventional therapies for knee pain (STEP Guidelines) from the American Society of Pain and Neuroscience. J Pain Res 2022; 15: 2683-2745
    CrossrefPubMedGoogle Scholar
  • 7 Migliore A, Gigliucci G, Alekseeva L. et al. Treat-to-target strategy for knee osteoarthritis. International technical expert panel consensus and good clinical practice statements. Ther Adv Musculoskelet Dis 2019; 11: 1759720X19893800
    CrossrefPubMedGoogle Scholar
  • 8 Zhang W, Moskowitz RW, Nuki G. et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008; 16 (02) 137-162
    CrossrefPubMedGoogle Scholar
  • 9 DeRogatis M, Anis HK, Sodhi N. et al. Non-operative treatment options for knee osteoarthritis. Ann Transl Med 2019; 7 (Suppl. 07) S245-S245
    CrossrefPubMedGoogle Scholar
  • 10 Zeni Jr JA, Axe MJ, Snyder-Mackler L. Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis. BMC Musculoskelet Disord 2010; 11 (01) 86
    CrossrefPubMedGoogle Scholar
  • 11 Bendich I, Halvorson RT, Ward D, Nevitt M. Predictors of a change in patient willingness to have total knee arthroplasty: insights from the osteoarthritis initiative. Knee 2020; 27 (03) 667-675
    CrossrefPubMedGoogle Scholar
  • 12 Postler A, Goronzy J, Günther KP. et al. Which disease-related factors influence patients' and physicians' willingness to consider joint replacement in hip and knee OA? Results of a questionnaire survey linked to claims data. BMC Musculoskelet Disord 2020; 21 (01) 352
    CrossrefPubMedGoogle Scholar
  • 13 Street Jr RL, Richardson MN, Cox V, Suarez-Almazor ME. (Mis)understanding in patient-health care provider communication about total knee replacement. Arthritis Rheum 2009; 61 (01) 100-107
    CrossrefPubMedGoogle Scholar
  • 14 Toye FM, Barlow J, Wright C, Lamb SE. Personal meanings in the construction of need for total knee replacement surgery. Soc Sci Med 2006; 63 (01) 43-53
    CrossrefPubMedGoogle Scholar
  • 15 Tallon D, Chard J, Dieppe P. Exploring the priorities of patients with osteoarthritis of the knee. Arthritis Care Res 2000; 13 (05) 312-319
    CrossrefPubMedGoogle Scholar
  • 16 Kroll TL, Richardson M, Sharf BF, Suarez-Almazor ME. “Keep on truckin'” or “It's got you in this little vacuum”: race-based perceptions in decision-making for total knee arthroplasty. J Rheumatol 2007; 34 (05) 1069-1075
    PubMedGoogle Scholar
  • 17 Suarez-Almazor ME, Richardson M, Kroll TL, Sharf BF. A qualitative analysis of decision-making for total knee replacement in patients with osteoarthritis. J Clin Rheumatol 2010; 16 (04) 158-163
    CrossrefPubMedGoogle Scholar
  • 18 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
    CrossrefPubMedGoogle Scholar
  • 19 Critical Appraisal Skills Programme. CASP qualitative checklist. Accessed November 30, 2022 at: https://casp-uk.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist-2018.pdf
    PubMed
  • 20 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological Index for Non-Randomized Studies (MINORS): development and validation of a new instrument. ANZ J Surg 2003; 73 (09) 712-716
    CrossrefPubMedGoogle Scholar
  • 21 Traumer L, Sørensen EE, Kusk KH, Skou ST. Investigating the motives of patients with knee OA undergoing a TKR: a qualitative interview study. Musculoskelet Care 2018; 16 (03) 380-387
    CrossrefPubMedGoogle Scholar
  • 22 O'Brien P, Bunzli S, Ayton D, Dowsey MM, Gunn J, Manski-Nankervis JA. What are the patient factors that impact on decisions to progress to total knee replacement? A qualitative study involving patients with knee osteoarthritis. BMJ Open 2019; 9 (09) e031310
    CrossrefPubMedGoogle Scholar
  • 23 Al-Taiar A, Al-Sabah R, Elsalawy E, Shehab D, Al-Mahmoud S. Attitudes to knee osteoarthritis and total knee replacement in Arab women: a qualitative study. BMC Res Notes 2013; 6: 406
    CrossrefPubMedGoogle Scholar
  • 24 Yeh WL, Tsai YF, Hsu KY, Chen DW, Chen CY. Factors related to the indecision of older adults with knee osteoarthritis about receiving physician-recommended total knee arthroplasty. Disabil Rehabil 2017; 39 (22) 2302-2307
    CrossrefPubMedGoogle Scholar
  • 25 Carnes D, Anwer Y, Underwood M, Harding G, Parsons S. TOIB study team. Influences on older people's decision making regarding choice of topical or oral NSAIDs for knee pain: qualitative study. BMJ 2008; 336 (7636): 142-145
    CrossrefPubMedGoogle Scholar
  • 26 Lenhard NK, Williams EE, Lape EC, MacFarlane LA, Losina E, Katz JN. Patient perspectives surrounding intraarticular injections for knee osteoarthritis: a qualitative study. Arthritis Care Res (Hoboken) 2022; 74 (03) 410-419
    CrossrefPubMedGoogle Scholar
  • 27 Khatri PJ, O'Connor AM, Dervin GF. Decision support needs of patients choosing between unicompartmental and total knee arthroplasty for advanced medial compartment osteoarthritis of the knee. J Arthroplasty 2011; 26 (08) 1343-1349
    CrossrefPubMedGoogle Scholar
  • 28 Fraenkel L, Fried T. If you want patients with knee osteoarthritis to exercise, tell them about NSAIDs. Patient 2008; 1 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 29 Fraenkel L, Bogardus Jr STJ, Concato J, Wittink DR. Treatment options in knee osteoarthritis: the patient's perspective. Arch Intern Med 2004; 164 (12) 1299-1304
    CrossrefPubMedGoogle Scholar
  • 30 Hutyra CA, Gonzalez JM, Yang JC. et al. Patient preferences for surgical treatment of knee osteoarthritis: a discrete-choice experiment evaluating total and unicompartmental knee arthroplasty. J Bone Joint Surg Am 2020; 102 (23) 2022-2031
    CrossrefPubMedGoogle Scholar
  • 31 Laba TL, Brien JA, Fransen M, Jan S. Patient preferences for adherence to treatment for osteoarthritis: the MEdication Decisions in Osteoarthritis Study (MEDOS). BMC Musculoskelet Disord 2013; 14: 160
    CrossrefPubMedGoogle Scholar
  • 32 Mitchell HL, Hurley MV. Management of chronic knee pain: a survey of patient preferences and treatment received. BMC Musculoskelet Disord 2008; 9: 123
    CrossrefPubMedGoogle Scholar
  • 33 Vina ER, Ran D, Ashbeck EL. et al. Patient preferences for total knee replacement surgery: relationship to clinical outcomes and stability of patient preferences over 2 years. Semin Arthritis Rheum 2016; 46 (01) 27-33
    CrossrefPubMedGoogle Scholar
  • 34 Weigl M, Pietzner J, Kisch R, Paulus A, Jansson V, Grill E. Effects of a medical second opinion programme on patients' decision for or against knee arthroplasty and their satisfaction with the programme. BMC Musculoskelet Disord 2021; 22 (01) 595
    CrossrefPubMedGoogle Scholar
  • 35 Riddle DL, Golladay GJ, Hayes A, Ghomrawi HMK. Poor expectations of knee replacement benefit are associated with modifiable psychological factors and influence the decision to have surgery: a cross-sectional and longitudinal study of a community-based sample. Knee 2017; 24 (02) 354-361
    CrossrefPubMedGoogle Scholar
  • 36 Lange T, Schmitt J, Kopkow C, Rataj E, Gunther KP, Lutzner J. What do patients expect from total knee arthroplasty? A delphi consensus study on patient treatment goals. J Arthroplast 2017; 32 (07) 2093
    CrossrefPubMedGoogle Scholar
  • 37 Sansom A, Donovan J, Sanders C. et al. Routes to total joint replacement surgery: patients' and clinicians' perceptions of need. Arthritis Care Res (Hoboken) 2010; 62 (09) 1252-1257
    CrossrefPubMedGoogle Scholar
  • 38 Clark JP, Hudak PL, Hawker GA. et al. The moving target: a qualitative study of elderly patients' decision-making regarding total joint replacement surgery. J Bone Joint Surg Am 2004; 86 (07) 1366-1374
    CrossrefPubMedGoogle Scholar
  • 39 Simic M, Harmer AR, Agaliotis M. et al. Clinical risk factors associated with radiographic osteoarthritis progression among people with knee pain: a longitudinal study. Arthritis Res Ther 2021; 23 (01) 160
    CrossrefPubMedGoogle Scholar
  • 40 Amoako AO, Pujalte GGA. Osteoarthritis in young, active, and athletic individuals. Clin Med Insights Arthritis Musculoskelet Disord 2014; 7: 27-32
    CrossrefPubMedGoogle Scholar
  • 41 Ackerman IN, Bucknill A, Page RS. et al. The substantial personal burden experienced by younger people with hip or knee osteoarthritis. Osteoarthritis Cartilage 2015; 23 (08) 1276-1284
    CrossrefPubMedGoogle Scholar
  • 42 Ghomrawi HMK, Lee LY, Nwachukwu BU. et al. Preoperative expectations associated with postoperative dissatisfaction after total knee arthroplasty: a cohort study. J Am Acad Orthop Surg 2020; 28 (04) e145-e150
    CrossrefPubMedGoogle Scholar
  • 43 Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 2017; 32 (12) 3854-3860
    CrossrefPubMedGoogle Scholar
  • 44 Leo RJ. Competency and the capacity to make treatment decisions: a primer for primary care physicians. Prim Care Companion J Clin Psychiatry 1999; 1 (05) 131-141
    PubMedGoogle Scholar
  • 45 Stiggelbout AM, Van der Weijden T, De Wit MP. et al. Shared decision making: really putting patients at the centre of healthcare. BMJ 2012; 344 (01) e256-e256
    CrossrefPubMedGoogle Scholar
  • 46 Agency for Healthcare Research and Quality. The SHARE Approach. Published online October 2020. Accessed March 30, 2023, at: https://www.ahrq.gov/health-literacy/professional-training/shared-decision/index.html
    PubMed
  • 47 Asan O, Yu Z, Crotty BH. How clinician-patient communication affects trust in health information sources: temporal trends from a national cross-sectional survey. PLoS One 2021; 16 (02) e0247583
    CrossrefPubMedGoogle Scholar
  • 48 Dang BN, Westbrook RA, Njue SM, Giordano TP. Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC Med Educ 2017; 17 (01) 32
    CrossrefPubMedGoogle Scholar
  • 49 Whitney RL, White AEC, Rosenberg AS, Kravitz RL, Kim KK. Trust and shared decision-making among individuals with multiple myeloma: a qualitative study. Cancer Med 2021; 10 (22) 8040-8057
    CrossrefPubMedGoogle Scholar
  • 50 Waldron T, Carr T, McMullen L. et al. Development of a program theory for shared decision-making: a realist synthesis. BMC Health Serv Res 2020; 20 (01) 59
    CrossrefPubMedGoogle Scholar
  • 51 Hsu KY, Tsai YF, Yeh WL, Chen DW, Chen CY, Wang YW. Triggers and decision-making patterns for receiving total knee arthroplasty among older adults with knee osteoarthritis: a qualitative descriptive study. J Clin Nurs 2018; 27 (23-24): 4373-4380
    CrossrefPubMedGoogle Scholar
  • 52 Al-Busaidi ZQ. Qualitative research and its uses in health care. Sultan Qaboos Univ Med J 2008; 8 (01) 11-19
    PubMedGoogle Scholar