University Center of Orthopaedics and Traumatology, University Medicine Carl, Gustav Carus Dresden, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
Center for Evidence-Based Healthcare, Medical Faculty, Technical University, Dresden, Dresden, Germany.
BMC Musculoskelet Disord. 2020 Jun 5;21(1):352. doi: 10.1186/s12891-020-03368-1.
A great heterogeneity in total joint replacement (TJR) rates has been reported for osteoarthritis (OA), most likely arising from a gap between patients' and physicians' views on the need for TJR. The purpose of this study therefore was to analyze potential cofactors which might influence the desire of patients to undergo TJR and physicians' willingness to discuss surgery with their patients.
A total of 8995 patients in Germany with a claims data diagnosis of hip or knee OA or polyarthrosis were asked to complete a questionnaire for this cross-sectional study of sociodemographic factors, indicators of current joint function (WOMAC score), willingness to undergo TJR and whether they had already discussed TJR with a physician. The overall response rate was 40%. Responders with polyarthrosis and individuals without current or chronic symptoms in the corresponding joints, pain in already replaced joints or simultaneous symptomatic hip and knee OA were excluded. We linked the survey results to claims data. Separate logistic regression models were used to assess which parameters were associated with patients' willingness to undergo TJR and physicians' discussion of surgery.
We analyzed 478 hip OA and 932 knee OA patients. Just 17% with hip OA and 14% with knee OA were willing to undergo TJR, although 44 and 45% had already discussed surgery with their physicians. Patients' willingness was associated with higher WOMAC scores, a deterioration of symptoms over the last 2 years, and previous TJR for another joint. The discussion with a physician was influenced by the impact on personal life and previous arthroplasty. Older age (odds Ratio (OR) 1.2 per 10 years), male sex (OR 0.69 vs female), longer symptom duration (OR 1.08 per 5 years), deterioration of symptoms (OR 2.0 vs no change/improvement), a higher WOMAC score (OR 1.3 per 10% deterioration) and reduced well-being (OR 1.1 per 10% deterioration) were associated with physician discussion in knee OA patients.
The proportion of patients willing to undergo TJR is lower than the proportion in whom physicians discuss surgery. While previous TJR seems to enhance patients' and surgeons' willingness, the influence of other cofactors is heterogeneous.
全膝关节置换术（TJR）的使用率存在很大差异，这很可能是由于患者和医生对 TJR 需求的看法存在差距所致。因此，本研究旨在分析可能影响患者接受 TJR 的意愿和医生与患者讨论手术的意愿的潜在因素。
德国共有 8995 名患有髋关节或膝关节骨关节炎或多关节炎的患者，他们被要求填写一份问卷，以了解社会人口统计学因素、当前关节功能指标（WOMAC 评分）、接受 TJR 的意愿以及是否已与医生讨论过 TJR。总的回复率为 40%。排除了多关节炎患者、相应关节无当前或慢性症状、已置换关节疼痛或同时患有症状性髋膝骨关节炎的个体。我们将调查结果与索赔数据相关联。使用单独的逻辑回归模型评估哪些参数与患者接受 TJR 的意愿和医生讨论手术相关。
我们分析了 478 名髋关节骨关节炎患者和 932 名膝关节骨关节炎患者。只有 17%的髋关节骨关节炎患者和 14%的膝关节骨关节炎患者愿意接受 TJR，尽管 44%和 45%的患者已经与医生讨论过手术。患者的意愿与较高的 WOMAC 评分、过去 2 年症状恶化以及其他关节的 TJR 有关。与医生讨论手术的情况受到对个人生活的影响和先前关节置换术的影响。年龄较大（每增加 10 岁，OR 为 1.2）、男性（OR 为 0.69 比女性）、症状持续时间较长（每增加 5 年，OR 为 1.08）、症状恶化（OR 为 2.0 比无变化/改善）、WOMAC 评分较高（每恶化 10%，OR 为 1.3）和幸福感降低（每恶化 10%，OR 为 1.1）与膝关节骨关节炎患者的医生讨论相关。
愿意接受 TJR 的患者比例低于与医生讨论手术的患者比例。虽然先前的 TJR 似乎增强了患者和外科医生的意愿，但其他因素的影响是异质的。
