Patient and Surgeon Risk-Taking Regarding Total Joint Arthroplasty

Published:December 21, 2021DOI:


      • Compared risk-taking attitudes between patients considering arthroplasty & surgeons.
      • General risk-taking was similar between groups, except (marginally) in driving.
      • Also compared willingness to have/recommend surgery under different scenarios.
      • Patients were more willing than surgeons in lower-benefit higher-harm scenarios.
      • Patients were also more often indifferent between complication risks than surgeons.



      Decisions regarding care for osteoarthritis involve physicians helping patients understand likely benefits and harms of treatment. Little work has directly compared patient and surgeon risk-taking attitudes, which may help inform strategies for shared decision-making and improve patient satisfaction.


      We surveyed patients contemplating total joint arthroplasty visiting a high-volume specialty hospital regarding general questions about risk-taking, as well as willingness to undergo surgery under hypothetical likelihoods of moderate improvement and complications. We compared responses from surgeons answering similar questions about willingness to recommend surgery.


      Altogether 82% (162/197) of patients responded, as did 65% (30/46) of joint replacement surgeons. Mean age among patients was 66.4 years; 58% were female. Surgeons averaged 399 surgeries in 2019. Responses were similar between groups for general, health, career, financial, and sports/leisure risk-taking (P > .20); surgeons were marginally more risk-taking in driving (P = .05). For willingness to have or recommend surgery, as the chance of benefit decreased, or the chance of harm increased, the percentage willing to have or recommend surgery decreased. Between a 70% and 95% chance of moderate improvement (for a 2% complication risk), as well as between a 90% and 95% chance of moderate improvement (for 4% and 6% complication risks), the percentage willing to have or recommend surgery was indistinguishable between patients and surgeons. However, for lower likelihoods of improvement, a higher percentage of patients were willing to undergo surgery than surgeons recommended. Patients were also more often indifferent between complication risks.


      Although patients and surgeons were often willing to have or recommend joint replacement surgery at similar rates, they diverged for lower-benefit higher-harm scenarios.


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        • Falk A.
        • Becker A.
        • Dohmen T.
        • Enke B.
        • Huffman D.
        • Sunde U.
        Global evidence on economic preferences.
        Quarterly J Economics. 2018; 133: 1645-1692
        • Beauchamp J.P.
        • Cesarini D.
        • Johannesson M.
        The psychometric and empirical properties of measures of risk preferences.
        J Risk Uncertain. 2017; 54: 203-237
        • Saleh K.J.
        • Mulhall K.J.
        • Bershadsky B.
        • Ghomrawi H.M.
        • White L.E.
        • Buyea C.M.K.K.
        Development and validation of a lower-extremity activity scale. Use for patients treated with revision total knee arthroplasty.
        J Bone Joint Surg Am. 2005; 87: 1985-1994
        • Lyman S.
        • Lee Y.Y.
        • Franklin P.D.
        • Li W.
        • Cross M.B.
        • Padgett D.E.
        Validation of the KOOS, JR: a short-form knee arthroplasty outcomes survey.
        Clin Orthop Relat Res. 2016; 474: 1461-1471
        • Lyman S.
        • Lee Y.Y.
        • Franklin P.D.
        • Li W.
        • Mayman D.J.
        • Padgett D.E.
        Validation of the HOOS, JR: a short-form hip replacement survey.
        Clin Orthop Relat Res. 2016; 474: 1472-1482
        • Iqbal S.
        • Selim A.
        • Qian S.
        • Lee A.
        • Ren X.S.
        • Rothendler J.
        • et al.
        The veterans RAND 12 item health survey (VR-12): what it is and how it is used.
        Qual Life Res. 2009; 18: 43-52
        • Mancuso C.A.
        • Sculco T.P.
        • Wickiewicz T.L.
        • Jones E.C.
        • Robbins L.
        • Warren R.F.
        • et al.
        Patients’ expectations of knee surgery.
        J Bone Joint Surg Am. 2001; 83: 1005-1012
        • Bourne R.B.
        • Chesworth B.M.
        • Davis A.M.
        • Mahomed N.N.
        • Charron K.D.J.
        Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?.
        Clin Orthop Relat Res. 2010; 468: 57-63
        • Dunbar M.J.
        • Richardson G.
        • Robertsson O.
        I can’t get no satisfaction after my total knee replacement: rhymes and reasons.
        Bone Joint J. 2013; 95-B: 148-152
        • Ghomrawi H.M.K.
        • Ferrando N.F.
        • Mandl L.A.
        • Do H.
        • Noor N.
        • Gonzalez Della Valle A.
        How often are patient and surgeon recovery expectations for total joint arthroplasty aligned? Results of a pilot study.
        HSS J. 2011; 7: 229-234
        • O’Neill J.
        • Williams J.R.
        • Kay L.J.
        Doctor-patient communication in a musculoskeletal unit: relationship between an observer-rated structured scoring system and patient opinion.
        Rheumatology. 2003; 42: 1518-1522
        • Stacey D.
        • Légaré F.
        • Lewis K.
        • Barry M.J.
        • Bennett C.L.
        • Eden K.B.
        • et al.
        Decision aids for people facing health treatment or screening decisions ( Review ) summary of findings for the main comparison.
        Cochrane Database Syst Rev. 2017; : 1-242
        • Klifto K.
        • Klifto C.
        • Slover J.
        Current concepts of shared decision making in orthopedic surgery.
        Curr Rev Musculoskelet Med. 2017; 10: 253-257
        • Pucher P.H.
        • Johnston M.J.
        • Archer S.
        • Whitby J.
        • Dawson P.M.
        • Arora S.
        • et al.
        Informing the consent process for surgeons: a survey study of patient preferences, perceptions, and risk tolerance.
        J Surg Res. 2019; 235: 298-302
        • Bono C.M.
        • Harris M.B.
        • Warholic N.
        • Katz J.N.
        • Carreras E.
        • White A.
        • et al.
        Pain intensity and patients’ acceptance of surgical complication risks with lumbar fusion.
        Spine (Phila Pa 1976). 2013; 38: 140-147
        • Copsey B.
        • Buchanan J.
        • Fitzpatrick R.
        • Lamb S.E.
        • Dutton S.J.
        • Cook J.A.
        Duration of treatment effect should Be considered in the design and interpretation of clinical trials: results of a discrete choice experiment.
        Med Decis Mak. 2019; 39: 461-473
        • Hutyra C.A.
        • Gonzalez J.M.
        • Yang J.-C.
        • Johnson F.R.
        • Reed S.D.
        • Amendola A.
        • et al.
        Patient preferences for surgical treatment of knee osteoarthritis.
        J Bone Joint Surg Am. 2020; 102: 2022-2031
        • Schwarzkopf R.
        • Kahn T.L.
        Patient risk taking and spending habits correlate with willingness to pay for novel total joint arthroplasty implants.
        Arthroplast Today. 2015; 1: 14-18
        • Szawlowski S.
        • Choong P.F.M.
        • Li J.
        • Nelson E.
        • Nikpour M.
        • Scott A.
        • et al.
        How do surgeons’ trade-off between patient outcomes and risk of complications in total knee arthroplasty? a discrete choice experiment in Australia.
        BMJ Open. 2019; 9: e029406
        • Andruchow J.E.
        • Raja A.S.
        • Prevedello L.M.
        • Zane R.D.
        • Khorasani R.
        Variation in head computed tomography use for emergency department trauma patients and physician risk tolerance.
        Arch Intern Med. 2012; 172: 660-661
        • Pines J.M.
        • Isserman J.A.
        • Szyld D.
        • Dean A.J.
        • McCusker C.M.
        • Hollander J.E.
        The effect of physician risk tolerance and the presence of an observation unit on decision making for ED patients with chest pain.
        Am J Emerg Med. 2010; 28: 771-779
        • Pines J.M.
        • Hollander J.E.
        • Isserman J.A.
        • Chen E.H.
        • Dean A.J.
        • Shofer F.S.
        • et al.
        The association between physician risk tolerance and imaging use in abdominal pain.
        Am J Emerg Med. 2009; 27: 552-557
        • Johnson F.
        • Hauber B.
        • Özdemir S.
        • Siegel C.A.
        • Hass S.
        • Sands B.E.
        Are gastroenterologists less tolerant of treatment risks than patients? Benefit-risk preferences in Crohn’s disease management.
        J Manag Care Pharm. 2010; 16: 616-628
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • Elliott V.
        • Fernandez M.
        • Neal L.O.
        • et al.
        The REDCap consortium: building an international community of software platform partners.
        J Biomed Inform. 2020; : 1-24
        • Fontana M.A.
        • Lyman S.
        • Sarker G.K.
        • Padgett D.E.
        • MacLean C.H.
        Can machine learning algorithms predict which patients will achieve minimally clinically important differences from total joint arthroplasty?.
        Clin Orthop Relat Res. 2019; 477: 1267-1279
        • Dohmen T.
        • Falk A.
        • Huffman D.
        • Sunde U.
        • Schupp J.
        • Wagner G.G.
        Individual risk attitudes: measurement, determinants, and behavioral consequences.
        J Eur Econ Assoc. 2011; 9: 522-550
        • Goodman S.M.
        • Mehta B.
        • Mandl A.L.
        • Szymonifka J.
        • Finik J.
        • Figgie M.
        • et al.
        Validation of the hip disability and osteoarthritis outcome score and knee injury and osteoarthritis outcome score pain and function subscales for use in total hip replacement and total knee replacement clinical trials.
        Physiol Behav. 2017; 176: 139-148
        • Binder S.
        • Nuscheler R.
        Risk-taking in vaccination, surgery, and gambling environments: evidence from a framed laboratory experiment.
        Health Econ. 2017; 26: 76-96
        • Morgan D.J.
        • Scherer L.D.
        • Korenstein D.
        Improving physician communication about treatment decisions: reconsideration of “risks vs benefits.”.
        JAMA. 2020; 324: 937-938
        • Saigal R.
        • Clark A.J.
        • Scheer J.K.
        • Smith J.S.
        • Bess S.
        • Mummaneni P.V.
        • et al.
        Adult spinal deformity patients recall fewer than 50% of the risks discussed in the informed consent process preoperatively and the recall rate worsens significantly in the postoperative period.
        Spine (Phila Pa 1976). 2015; 40: 1079-1085