Jg. Wright et al., VARIATION IN ORTHOPEDIC SURGEONS PERCEPTIONS OF THE INDICATIONS FOR AND OUTCOMES OF KNEE REPLACEMENT, CMAJ. Canadian Medical Association journal, 152(5), 1995, pp. 687-697
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.