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Decision Point for Joint Replacement

Many patients could use a joint replacement. Often they refuse to even think about it. What's the hold up? That's what researchers in Canada set out to discover. This study focused on 17 adults with moderate to severe arthritis. All were good candidates for joint replacement. All were unwilling to consider it.

The patients were interviewed and asked questions in two key areas. The first was about the information they had received about the operation. Questions were also included to find out what kind of support patients expected if they had the surgery. The second area addressed the needs and desires that were important to the patients. These questions focused on arthritis management and care after joint replacement.

The researchers used the patients' answers to understand what decision-making process is used. Did the individuals weigh the risks and benefits of joint replacement? Did they compare all treatment options?

The authors report that no one single event made people decide about joint replacement. It's more likely that a slow increase in pain and loss of function are the key factors. Patients are less likely to think about a joint implant if the pain comes and goes. The same is true if they have some function and can get around despite the pain.

The decision to have a joint replacement is complex. For many patients it's more than just looking at the pros and cons. People consider many factors and use information from many sources. For example, even with severe pain and disability, many patients don't think their situation is bad enough for surgery. Or they've heard there's even more pain after the operation. Some don't see the value given their own limited life span.

Most patients rely on their friends and peers to tell them about the operation. The authors of this report suggest this means patients may not get accurate information about their own case. Understanding how patients make this decision may help doctors guide patients in their treatment.

References: Jocalyn P. Clark, MSc, PhD, et al. The Moving Target: A Qualitative Study of Elderly Patients' Decision-Making Regarding Total Joint Replacement Surgery. In The Journal of Bone and Joint Surgery. July 2004. Vol. 86-A. No. 7. Pp. 1366-1375.

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