Knee Osteoarthritis: To Cut or Not to Cut; A Question to Understand

Background & Purpose: Knee Osteoarthritis (KOA) is a painful chronic health condition which can lead to debilitating limitations in activities of daily living, reduced health quality of life, social isolation, negative physical and mental functioning, and substance use. Primarily associated with aging and older adults, KOA is increasing due to obesity and sports-related injuries. In the US, medical costs exceed $50b per year for total knee replacement (TKR) surgery. Research remains limited regarding the factors influencing the decision-making (DM) process for those seeking a TKR. This paper highlights primary data from a DM survey identifying factors influencing TKR surgery. TKR DM was part of a larger research project to develop revolutionary and transformative biomedical technology in the treatment of KOA.

Methods: Participants were recruited to participate in listening sessions to discuss their lived experiences with chronic knee pain (CKP), KOA or having undergone TKR surgery. The Barriers to Arthroplasty (BAS) was used to collect information on five dimensions related to DM regarding TKR surgery. Participants completed the BAS online, as part of the registration process or when participating in a joint education seminar prior to TKR surgery. Only those who had not undergone a TKR were eligible to complete the BAS. The 22-item BAS covers: (1) cost & insurance; (2) recovery; (3) trust in surgeon; (4) surgical outcomes; and (5) timing.

Results: A total of 67 respondents completed the BAS. Women made up 82% of the sample, while 40% were non-white. The mean age of the respondents was 69.22. The BAS had an overall alpha of .91 which is consistent with the original scale. Significant differences related to non-white and white respondents were found in three aspects: cost; trust in surgeon, and time of TKR. Consistent with extant research, non-whites had higher agreement on the importance of finding a surgeon with similar demographics and whom they could trust (p<.001). Individuals with health insurance other than Medicare, were found to be more concerned about the timing of the TKR surgery (p=.001) as most coverages consider this procedure as elective. Recovery was significant (p=.041) for those who had insurance other than Medicare. Those with Medicare were more concerned with being healthy enough to undergo surgery (p=.028).

Conclusions & Implications: Decision-making regarding TKR is influenced by the interaction of multiple variables each of which social work input and understanding can facilitate the process. For example, TKR is considered an elective surgery by many health insurance coverages other than Medicare thus necessitating a waiting period until that coverage is available. This in turn contributes to longer periods of time living with chronic and possibly debilitating pain for those with KOA. Continued research into non-traditional avenues of empirical inquiry allow for the expansion of transformative social work contributions to individual health decision-making across multiple avenues. Additionally, social work can and must have a clear and necessary role in emerging and transformative research intersecting with STEM related areas to promote equitable policy development and direction.