Surgeons’ familiarity with UKR determines clinical recommendations for knee OA patients

Issue: Issue 5 2010

OSLO — Orthopaedic surgeons from England and Wales with varied exposure to and experience performing unicompartmental knee replacement made different decisions about which procedure — total or unicompartmental knee replacement — was most appropriate for patients with late-stage medial compartment knee osteoarthritis, according to a study presented at the 2010 ESSKA Congress, here.

Although the four surgeons who participated in the study were not offered the opportunity to explain their rationale for their selections, the researchers linked the surgeons’ preference for either technique to their familiarity with each procedure.

In discussing a slide that summarized the surgical recommendations received from an experienced surgeon from a specialist unicompartmental knee replacement (UKR) center down to a trainee, David J. Beard, MSc, DPhil, of the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science at the University of Oxford, noted, “There is a significant difference in the percentages in terms of what they would do.”

In the study conducted by Beard and colleagues, all participants were given the same immediate preoperative radiographs and basic clinical information for a group of 140 late-stage knee osteoarthritis patients who all required knee replacement. The surgeons were asked to decide, on the spot, whether they would likely perform UKR or total knee replacement (TKR) in each case.

Study participants represented four levels of expertise with UKR: a UKR expert working at a designer surgeon center, an orthopaedist specializing in knee surgery (including UKR), a lower limb arthroplasty surgeon who typically refers UKR cases out, and a year-six trainee.

Additional clinical and demographic data were subsequently provided to the study participants, but 80% to 89% of their decisions about the appropriate surgery stayed the same.

The surgeon who worked at a specialist UKR center selected UKR in 80% of the cases, while surgeons at other centers where TKR was predominantly performed chose UKR about half as often.

To check how consistent the surgeons’ decisions were, 3 months later they were asked to assess the same radiographs and select a treatment.

“There is some reassurance there that the variation is not within the surgeons and that they do make consistent decisions within the same patient,” Beard said. He noted that this study’s findings do not indicate the best treatment, but that the type of treatment a late-stage knee osteoarthritis patient will receive likely depends on who they consult.

Beyond exposure to TKR or UKR, a surgeon’s results with a given operation may affect his or her choice. However, because the study provided no insight into where the variation in treatment choice originates, further study is needed, Beard said. – by Susan M. Rapp

Reference:

Beard D, Price AJ, Holt M, et al. Total or partial knee replacement: the variation in treatment choice for late stage osteoarthritis. Paper FP12-1357. Presented at the 2010 ESSKA Congress. June 9-12, 2010. Oslo.

David J. Beard, MSc, DPhil, can be reached at Oxford Orthopaedic Engineering Centre, Windmill Road, Oxford, OX3 7LD, United Kingdom; +44-1865-227374; e-mail: david.beard@ndorms.ox.ac.uk. His study was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme.

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