VARIATION IN ORTHOPEDIC SURGEONS PERCEPTIONS OF THE INDICATIONS FOR AND OUTCOMES OF KNEE REPLACEMENT

Objective: To determine the agreement among orthopedic surgeons' indic ations for knee replacement their perceptions of the usefulness of var ious treatments for osteoarthritis of the knee and their expected outc omes of knee replacement, and to determine the relation between these opinions and the number of knee replacement procedures performed by in dividual surgeons. Design: Survey. Setting: Ontario. Participants: All 392 orthopedic surgeons in the province. Of the 325 practising tracea ble surgeons 234 (72.0%) responded. Outcome measures: Indications for knee replacement, perceived usefulness of treatments for osteoarthriti s, perceived outcomes of knee replacement and number of knee replaceme nt procedures performed by individual surgeons. Results: The responden ts disagreed on how 20 of 34 patient characteristics affected their de cision to perform knee replacement surgery. They also disagreed on the usefulness of seven of eight treatments for arthritis of the knee. Th e respondents demonstrated variation in their expected outcomes of kne e replacement. The surgeons who performed more procedures judged, on a verage, the outcomes to be better and to have fewer complications than the surgeons who performed fewer procedures. Conclusions: Orthopedic surgeons demonstrated disagreement about some of the indications for k nee replacement, the usefulness of treatments for arthritis of the kne e and the perceived outcomes of knee replacement. The areas of greates t disagreement should be the focus of future research and the developm ent of practice guidelines.