CAN SURGEON’S AGREE ON PATIENT PRIORITY FOR TOTAL KNEE ARTHROPLASTY SURGERY?

Abstract

The demand for knee arthroplasty (TKR) is increasing yet there are no established criteria for prioritizing patients. We investigated surgeon inter-observer reliability and factors that influenced their prioritization of patients by having three surgeons each independently consult on twelve randomly selected patients waiting for TKR. Surgeons had high reliability and were most influence by the patient’s pain and gait pattern when assigning priority. Surgeon assigned priority also correlated with common subjective outcome metrics. Formalized gait assessment may allow for more objective prioritization of patients waiting for TKR.

The purpose of this study was to investigate the inter-observer reliability of surgeons assessing the priority of patients waiting for elective total knee arthroplasty (TKR) surgery, and to assess the discriminative methodology surgeons employ when assessing patients.

Surgeon’s can reliably assign a priority to their patients waiting for TKR. Surgeons generally consider the patients pain and gait pattern when assigning priority.

Wait lists for elective TKR are increasing and the demand will continue to grow. Objective criteria for prioritizing patients would allow for rational delivery of limited surgical resources.

Surgeons have high inter-observer reliability when assigning patient priority (ICC = 0.86). Pain and gait pattern have a significant impact on the surgeon’s assessment of priority (p=0.25 and p< 0.001, respectively). The oxford twelve most closely correlated to the surgeon’s prioritization (r=0.80).

Twelve patients waiting for TKR were randomly selected from three surgeons wait lists. Each surgeon independently examined all twelve patients and recorded their assessment of the patient’s acuity (priority) on a visual analogue scale. The impact of various aspects of the patient’s presentation on the surgeon’s assessment, such as pain control, function, gait, joint contracture and radiographic appearance, were recorded. All patients completed the SF-36, Oxford twelve and WOMAC questionnaires. Linear regression and Intra-Class Correlation Coefficients were used to assess the data.

Through the complex patient-surgeon interaction during a standard consultation, surgeons are able to prioritize their patient’s with high reliability. Improved objective metrics for prioritizing patient’s may be possible by more formalized methods of gait assessment.