Factors Affecting Osteoarthritis Patients Decision to Undergo Knee Replacement Surgery: An Exploratory Study

Abstract

Background: Osteoarthritis is the second most common chronic degenerative rheumatologic disorder affecting over 180 million people in India. It is estimated to be tenth leading cause of most disabling diseases and non-fatal burden in developed countries. Knee replacement is an accepted, cost effective and underutilized treatment for moderate-severe form of arthritis which has shown great outcomes, but it is often seen that patients do not opt for it until the disability increases to a point where pain is unbearable and affects their activities of daily living (ADLs). Thus, this research aims to obtain clarity and good knowledge about patients’ perspective by exploring various factors affecting their decision to undergo Total Knee Replacement. Objectives: To assess the factors affecting the decision to undergo knee replacement surgery among osteoarthritis patients. Design: An exploratory quantitative study. Settings: Orthopedic ward of a superspeciality hospital of North India. Participants: 100 knee osteoarthritis patients selected using non-probability purposive sampling. Methods: A standardized tool ‘Index of severity for knee osteoarthritis’ by Lequesene et al, and a self-designed questionnaire were used to obtain data. Descriptive and Inferential statistical tests (chi square, ANOVA) were used. Results: The mean duration of osteoarthritis among patients ranged between 1 and 20 years with score of index of severity 14.8600+3.44369, depicting moderate to extremely severe symptoms. The factors which were significant in decision making process were: positive experience of knee Replacement by known person, family support and positive opinion regarding surgery, availability of care giver, good repute of orthopedic surgeon, positive expectations of surgical outcome and recovery (p=0.000). It was also revealed that the health aspects such as joint involvement of both knees, use of alternative medicines, presence of co morbidities, no past history of surgery, positive experience of previous surgeries were significant factors aiding the decision making. Conclusion: Numerous factors emerged out to be of significance in decision making process to choose for undergoing Knee Replacement. The knowledge about factors will aid in forming effective guidelines, protocols, or policies and training of medical health professionals’’ to promote informed decision making widely in medical settings and optimize patient outcomes and health care delivery.