A recently published study about decision making for knee replacement surgery had some interesting findings. The study was based on research from the Creaky Joints community, an online base for thousands of Americans dealing with arthritis and joint problems. It was published in “Arthritis Care and Research,” a medical journal put out by The Association of Rheumatology Health Professionals and The American College of Rheumatology.
Patient decision-making and numbers
When a patient must decide whether to undergo a total knee replacement, doctors show them the numbers. Of recovering patients, outcomes and satisfaction vary. Out of fifty people, forty-two have positive results and would do the surgery again. Their surgery went well, their knees feel greatly improved, and they are highly satisfied. Out of the same fifty, seven didn’t do as well as they’d hoped. They still experience some pain, their situation was not greatly enhanced, and they don’t think they would do it again. Of those fifty, only one regrets the surgery. She had some kind of complication, often an infection in the new knee, and she would definitely not have it again if she needed it in her other knee.
Dr. Liana Fraenkel, a Yale-trained physician who led the study, weighed in on the benefits of visual aids. “The vast majority of people who undergo total knee replacement surgery have high satisfaction following the procedure; however, the decision to undergo major surgery is complicated when a patient either underestimates the potential benefits or overestimates their risk for complications.”
When presented with the numbers, she explained, the information make it appear more negative than it is in actuality. The initiators of the study wanted to see if they could present the information with visuals. The expectation was that the visuals might help the patients envision the outcomes, which are highly positive, in a more objective light.
How the study worked
The study recruited people living in the US over age fifty who had rheumatic or osteoarthiritc knee problems. They’d also never had knee surgery.
All of the participants saw these numbers at the outset, with the three potential outcomes. They were then randomly distributed into four groups. The first only saw these numbers. The second saw the options with colors indicating each of the probabilities. The third saw the numbers interspersed with fifty images of variously happy or discontent people. And the last group had the numbers and clicked on a graphical spinner.
The results were in line with expectations. They showed that the people in the second two groups, which both had visual aids to show the possible outcomes from knee replacement surgery, had a higher preference for it. This was true even after taking into account insurance, knee pain, age and other variables.
Total knee replacement
There are several options when it comes to knee replacement. First, doctors will recommend various therapies and medications. If those don’t work to relieve pain, they may consider replacing part of the knee. If there is ongoing pain and the knee has deteriorated, doctors will recommend a total knee replacement. In this procedure, the knee bones are replaced by metal and plastic parts.
For most patients, a total knee replacement relieves the pain completely and the patient returns to a healthy life. In a minority of cases, as mentioned above, the patient may experience further pain or complications. The authors of the study are hopeful that visual aids will help patients in their decision-making.
At Sinai Post Acute Care, our staff is trained to cater to patients post knee replacement surgery. We offer premium services to help them have a positive experience, including physical and occupational therapy. We take patients straight from the hospitals, such as University Hospital, Newark Beth Israel Medical Center, and East Orange Hospital.