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BACKGROUND: Patients with medial unicompartmental osteoarthritic disease of the knee requiring arthroplasty can be treated with either Total or Unicompartmental Knee Replacement (TKR or UKR). Currently, the decision to choose one operation over another is not well defined and may depend on the profile of the surgeon consulted. We tested the hypothesis that different surgeons will select different treatment for identical patients requiring knee replacement. METHOD: Four different surgeons, representing four different levels of expertise, made a forced choice decision of whether they would perform TKR or UKR based on radiographs alone and subsequent additional clinical information including gender and age, in 140 patients. Individual surgeon repeatability was tested by repeat assessment 3 months later. RESULTS: The knee surgeon from the UKR design centre would have performed a UKR in up to 88% of the patients. The remaining surgeons would have performed UKR in 29-48% of patients; a variation in decision making of up to 59%. Additional clinical information had little effect on decision making with surgeons maintaining their radiographic based choice in 80 to 87% of cases. The repeatability study showed high within surgeon consistency for treatment choice. CONCLUSION: Surgeons, given identical information, do not concur on treatment for patients with the same pathology. The decision making process appears heavily influenced by radiographic findings but individual surgeons are consistent with their own treatment choice. The study shows that consensus treatment for medial osteoarthritis of the knee remains in question.

Original publication

DOI

10.1016/j.knee.2012.05.005

Type

Journal article

Journal

The Knee

Publication Date

12/2012

Volume

19

Pages

886 - 889

Addresses

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK. david.beard@ndorms.ox.ac.uk

Keywords

Humans, Osteoarthritis, Knee, Arthroplasty, Replacement, Knee, Health Care Surveys, Prosthesis Design, Knee Prosthesis, Decision Making, Orthopedics, Patient Selection, Clinical Competence, Adult, Physician's Practice Patterns, Female, Male