Investigating the motives of patients with knee OA undergoing a TKR: A qualitative interview study

Objective: Total knee replacement (TKR) is generally considered effective as treatment of pain and functional limitations in end-stage knee osteoarthritis (OA). However, many patients delay surgery for months or are unwilling to undergo TKR despite pain and functional limitations. Hence, a qualitatively assessment of what actually affects the patient's decision to undergo TKR would be important. Therefore, the purpose of this study was to investigate the motives of patients with knee OA choosing to undergo TKR and to explore the factors considered important during their decision-making process. Methods: Eleven patients undergoing TKR were recruited from the outpatient orthopedic department. Using an interview guide, in-depth semi-structured interviews were conducted at participants' home. All interviews were recorded, transcribed and a thematic analysis was performed. Results: The analysis revealed that the interaction between doctor and patient emerged as a factor highly influential on patients' decision-making process with patients choosing the treatment option suggested by the doctor. Using x-rays, revealing no cartilage between the bones, as a reason for choosing to undergo TKR was a legitimate argument among patients. The prospect of avoiding taking high doses of pain-relieving medication and hearing positive experiences of others who had undergone TKR motivated patients to undergo TKR. However, negative experiences of others were neglected. Conclusions: Patients' decision-making process was influenced by several factors, with some factors being more influential than others. Knowledge of which factors patients consider important in relation to their decision to undergo TKR can facilitate and support shared decision-making regarding TKR.