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Shared Decision Making for Total Joint Replacement: The Physician’s Role

Shared Decision Making for Total Joint Replacement: The Physician’s Role

Initial treatment for patients who have osteoarthritis (OA)—a leading cause of pain and disability in the United States—may include diet, exercise, and NSAIDs. However, pain may persist despite conservative therapy. Total joint replacement (TJR) surgery is an excellent option for relieving the pain associated with OA and restoring functional status. Rates of patient satisfaction with TJR are high, although the total costs of hospitalization, physician reimbursement, and rehabilitation are on the order of $25,000 per case.1

When considering TJR, patients often turn to their physicians for guidance. The concept of shared decision making (SDM) has gained popularity in the medical community, especially for elective procedures such as TJR. SDM is predicated on open communication between the physician and patient. The physician provides comprehensive information about the procedure and its risks, benefits, and alternatives, and the patient informs the physician about personal, social, and cultural factors that may affect his or her decision-making process.2 In practice, however, physicians cannot expect that all patients will disclose or even be aware of the many elements influencing their decisions.

In this article, we address 10 questions that patients frequently ask when they are considering TJR. We also discuss social and cultural influences on patients' perspectives about TJR.

 

THE QUESTIONS

1. Is TJR right for me?

TJR is a good option for patients who experience severe pain or functional impairment resulting from hip or knee OA. Candidates for TJR generally are patients for whom conservative treatment with medications and physical therapy has not been successful. Because TJR is an elective procedure, patients often differ in the extent of functional limitation they will tolerate before proceeding with surgery. Therefore, specifying a threshold level of functional limitation required to proceed with TJR is not possible or appropriate. Specifying a pain threshold is also inappropriate. Patients may cite several factors, such as pain that disturbs sleep, pain on walking short distances, and unremitting pain, as reasons to proceed to TJR.

 

 

2. How will I benefit from TJR?

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