Variability in Physician Opinions About the Indications for Knee Arthroplasty

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Abstract

To determine how much of variability in physician opinion about the indications for knee arthroplasty is due to inconsistency in individual physicians' opinions. We surveyed 201 orthopedic surgeons, 141 rheumatologists, and 455 family physicians. Physicians were asked how 34 patient characteristics affected their decision to perform or refer for knee arthroplasty. Surgeons and referring physicians agreed on how 4 and 2 of 34 patient characteristics affected their decision about knee arthroplasty, respectively. Half of the variability in opinion among physicians could be accounted for by inconsistency in their individual responses to the survey 6 weeks apart (mean intraclass correlation coefficient = 0.49). Although surgeons and referring physicians vary in their opinion, half of the variability could be attributed to individual physician inconsistency.

Section snippets

Materials and Methods

We surveyed a random sample of 201 orthopedic surgeons, all 141 practicing rheumatologists, and a random sample of 455 family physicians in Ontario. The sample was based on the Registry of the College of Physicians of Ontario. Nonresponders received up to 3 mailings and a subsequent telephone call. Physicians were eligible for the survey if they were in active practice and had seen patients with lower extremity arthritis in the previous year. A random subsample of 186 physicians completed the

Orthopedic Surgeons

Of the 201 surveyed surgeons, 135 (67%) responded, of whom 109 (80.7%) reported seeing patients with knee osteoarthritis. For the 109 respondents, the mean age was 46 years (range, 31-75 years), mean years in practice was 15 years (range, 1-42 years), 98 (90%) were male, 37 (34%) had a joint arthroplasty fellowship, and 36 (46%) of 79 who responded to the question indicated a university affiliation. Of the 34 characteristics (Table 1), more than 90% of surgeons agreed on only 4 characteristics

Discussion

Total knee arthroplasty results in substantial and sustained improvement in quality of life 2, 23. The utilization of knee arthroplasty has risen exponentially in both Canada [24] and the United States [25]. A survey in 1994 of referring physicians and orthopedic surgeons in Ontario [4] identified variability in how individual patient characteristics affected their decision to refer for or perform total knee arthroplasty. The results of this study demonstrated that physicians' opinions about

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    Supplementary material available at www.arthroplastyjournal.org.

    These benefits or support were received from Canadian Institute for Health Research.

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    James G. Wright, MD, MPH, FRCSC, Gillian A. Hawker, MD, MSc, FRCPC, Pamela L. Hudak, BScPT, PhD, Ruth Croxford, MSc, Richard H. Glazier, MD MPH, Nizar N. Mahomed, MD, ScD, FRCSC, Hans J. Kreder, MD, MPH, FRCSC, Peter C. Coyte, PhD.

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