Perspectives of orthopaedic surgeons on patients' appropriateness for total joint arthroplasty: a qualitative study

Rationale, aims and objectives As total joint arthroplasty ( TJA ) rates rise, there is need to ensure appropriate use. Our objective was to elucidate surgeons' perspectives on appropriateness for TJA . Methods Semi‐structured telephone interviews were conducted in a sample of orthopaedic surgeons that perform TJA in three C anadian P rovinces. Surgeons were asked to discuss their criteria for TJA appropriateness for osteoarthritis; potential value of a decision‐support tool to select appropriate candidates; and the role of other stakeholders in assessing appropriateness. Results Of 17 surgeons approached for participation, 14 completed interviews (12 males; 7 aged <50 years; 5 academic; 8 in urban practices). Surgeons agreed that pain and pain impact on patients' quality of life and function were the key criteria to assess appropriateness for TJA , but that these concepts were difficult to assess and not always congruent with structural changes on joint radiography. Some used a wider range of criteria, including their assessments of patient expectations, ability to cope and readiness for surgery. While patient age was not identified as a criterion itself, surgeons did acknowledge that appropriateness criteria may differ for younger versus older patients. Most agreed that a decision‐support tool would help ensure that all elements of appropriateness are assessed in a standardized manner, albeit the ultimate decision to offer surgery must be left to the discretion of surgeons, within the context of the doctor–patient relationship. Conclusions Surgeons recognized the need for a tool to support decision making for TJA , particularly in the context of increasing surgical demand in younger patients with less severe arthritis. The work to develop and test such a decision‐support tool is underway.