The Role of Risk Tolerance in a Patient’s Decision to Undergo Total Knee and Hip Arthroplasty

• Published in: The Journal of arthroplasty 2025-01, Vol.40 (1), p.40-44
• Main Authors: Blackburn, Amy Z., Prasad, Anoop K., Scott, Bryan L., Cote, Mark, Humphrey, Tyler J., Katakam, Akhil, Salimy, Mehdi S., Lim, Perry, Heng, Marilyn, Melnic, Christopher M., Bedair, Hany S.
• Format: Article
• Language: English
• Subjects: Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Bayes Theorem; Decision Making; discrete choice experiment; Female; grit; Humans; Male; Middle Aged; resilience; Retrospective Studies; Risk Assessment; Risk Factors; risk tolerance; total hip arthroplasty; total knee arthroplasty
• ISSN: 0883-5403; 1532-8406; 1532-8406
• DOI: 10.1016/j.arth.2024.07.033

A patient’s decision-making process to undergo surgery is crucial for surgeons to understand for patient-counseling purposes. Total knee and hip arthroplasty, like any other major surgery, is associated with serious, sometimes life-threatening, complications. Using the results of discrete choice experiments (DCEs), we aimed to understand the relationship between a patient’s risk tolerance and choosing to undergo surgery in real life. This is a retrospective study of prospectively collected DCE results for 142 potential knee or hip arthroplasty clinic patients from October 2021 to March 2022. The DCE presented the patient with 2 scenarios, each of which was made up of different combinations of attributes and levels. A hierarchal Bayesian model was used to obtain a risk score that reflected the risk attributes chosen by each patient. Logistic regressions were then used to evaluate the association between a patient’s willingness to incur risk and their decision to undergo a total joint arthroplasty. Of the 142 patients enrolled in the DCE, 89 (62.3%) underwent a total joint arthroplasty. Risk score (odds ratio [OR] = 2.6, 95% confidence interval [CI] 1.1 to 6.6, P = 0.04), men (OR = 2.5, 95% CI 1.1 to 5.9, P = 0.028), and patients who have hip osteoarthritis (OR = 2.4, 95% CI 1.1 to 5.5, P = 0.036) increased the odds of undergoing arthroplasty, whereas physical function of at least 75% at the initial visit (OR = 0.3, 95% CI 0.1 to 0.7, P = 0.004) decreased these odds. We found that a patient’s willingness to incur risk, lower baseline physical function, and men were all independently associated with undergoing total knee arthroplasty. We believe that these findings prompt much-needed future studies that focus solely on the relationship between patients’ inherent risk behavior and surgical and patient-reported outcomes.