INDICATIONS FOR TOTAL HIP AND TOTAL KNEE ARTHROPLASTIES - RESULTS OF ORTHOPEDIC SURVEYS

A lack of consensus regarding the indications for total hip arthroplas ty (THA) and total knee arthroplasty (THA) has been cited as one reaso n for the variations in the rates of THA and TKA across the United Sta tes. The purposes of this study were to survey orthopaedists in a spec ific geographic area (New York City) regarding the candidacy of patien ts with osteoarthritis for THA or TKA and to compare indications for T HA between orthopaedists at two academic medical centers, The Hospital for Special Surgery in the United Slates and McGill University in Can ada. Orthopaedists were sent mail surveys asking about indications, fa ctors affecting outcomes, and factors that might modify decisions for surgery. Approximately 45% of orthopaedists who performed THA and TKA in New York City in 1992 completed the surveys. Although there were wi de variations among surgeons, most surgeons required at least severe p ain daily, rest pain several days per week, transfer pain either sever al days per week (THA) or daily (TKA), and destruction of most of the joint space on radiograph. Younger age, comorbidity, technical difficu lties, and lack of motivation modified the decision against surgery wh ereas the desire to be independent and return to work swayed the decis ion for surgery. Most surgeons rated that patients with severe pain, o steoarthritis, or rheumatoid arthritis would have a high likelihood of an excellent outcome, whereas those with comorbidity and certain tech nical factors would have only a moderate likelihood of an excellent ou tcome. In the U.S.-Canadian survey of THA, in which more than 90% of s urgeons responded, Canadian surgeons tended to require more frequent p ain and use of assistive devices for walking. Although there was a maj ority of opinion for several indications, there was no clear consensus among surgeons regarding the indications for THA and TKA. Possible ex planations for this are that isolated indications are not as important as integrating and weighing several indications and that I-he patient 's desire to proceed with THA or TKA is an important driving force in the decision to operate.