Online predictive tool may not affect patients’ willingness to undergo TKA
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Key takeaways:
- Use of a predictive tool did not significantly affect patients’ willingness to undergo total knee arthroplasty.
- Researchers noted predictive tools may still enhance health outcomes.
According to published results, use of a predictive tool may not significantly affect patient-reported willingness to undergo total knee arthroplasty at 6 months after use of the tool.
Researchers performed a parallel, double-masked, two-arm randomized clinical trial of 211 patients (mean age of 65.8 years) with knee osteoarthritis who were considering TKA between June 30, 2022, and July 31, 2023.
Researchers randomly assigned 105 patients to receive access to the SMART Choice tool, an online tool that uses registry data to predict improvements in health-related quality of life after TKA. Researchers assigned the remaining 106 patients to receive treatment as usual without access to the predictive tool. According to the study, the primary outcome measure was change in participants’ willingness to undergo surgery at 6 months after use of the tool.
Researchers found the predictive tool did not significantly reduce patients’ willingness to undergo TKA at 6 months (adjusted OR = 0.85). However, researchers noted use of predictive tools may still enhance health outcomes for patients with knee OA.
“These findings indicate that additional research is needed to optimize patient decision-making in TKA,” the researchers wrote in the study.
Perspective
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This was an interesting study out of the University of Melbourne. The authors aimed to study whether implementing a predictive tool for patients prior to surgery would influence a patient’s decision to move forward with a total knee replacement. Ultimately, their study concluded that the predictive tool did not impact the decision to move forward with surgery.
The authors should be commended for the excellent study design given the randomized control trial. However, the study and the conclusions have shown that the decision for surgery, specifically a knee replacement, is a complex one. It is a personalized and patient-specific decision, which makes it challenging for a “predictive” tool to sway a decision strongly. I agree with the authors that more work in this space is warranted as setting patient expectations early preoperatively will ultimately help outcomes after TKR. Inappropriate patient expectations are often the reason for dissatisfaction after TKR. However, I think the orthopedic research community should also be spending our energy to identify methods to better predict how to personalize knee replacement surgery to match individual patient expectations.
There are several methodologies and techniques on how to perform knee replacements today; however, we do not yet know how to match these individual methods to different patient needs. I believe the future of knee replacements will be customizing what we do and how we do it for each patient. Studying the data we now have through robotic knee replacements, together with patient-reported outcomes, will help us get there.
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