TRICOMPARTMENTAL KNEE REPLACEMENT A COMPARISON OF ORTHOPEDIC SURGEONSSELF-REPORTED PERFORMANCE RATES WITH SURGICAL INDICATIONS, CONTRAINDICATIONS, AND EXPECTED OUTCOMES

The chance of a person with osteoarthritis of the knee receiving a kne e replacement is highly variable. To understand better the reasons for this variation, all practicing orthopaedists in Indiana were surveyed about their management of severe knee osteoarthritis and their percep tion of tricompartmental knee replacement as a therapeutic option. The ir perceptions of indications and outcomes of knee replacement were co mpared with the self reported annual number of patients for whom they performed (or referred to other surgeons for) tricompartmental knee re placements. A completed survey was returned by 220 (79%) of the 280 or thopaedists surveyed; analyses were limited to the 188 respondents who had cared for at least one patient with osteoarthritis of the knee in the prior 2 weeks (mean = 13). These surgeons reported performing (or referring patients for) a mean of 31 knee replacements in the prior y ear (SD 45, median 21, range 0-480 knee replacements). There was stron g agreement (>95%) among respondents for seven (21%) of 33 surgical in dications and contraindications, and more general agreement (>60%) for 21 (64%). In the five factors (15%) for which there was disagreement, there was no consistent relationship between opinions and self report ed knee replacement performance rate. Surgeons reporting more knee rep lacements had significantly higher estimates of pain relief and functi onal improvement following surgery, and lower estimates of prosthesis infection and failure rates. When all responses were considered togeth er, four decision factors correlated independently with the performanc e of more knee replacements, but these four factors explained only 24% of the variation in self reported knee replacement performance. Other reasons for such variation, such as access to orthopaedic surgeons pe rforming knee replacements, decision making of referring physicians, a nd patient perceptions about knee replacement should be explored.