Improving Management of Osteoarthritis: Patients Perceptions of a Surgical Readiness Interview Tool

Research Article

J Fam Med. 2021; 8(7): 1268.

Improving Management of Osteoarthritis: Patients’ Perceptions of a Surgical Readiness Interview Tool

Barton KI1,2,3*, Hewison CE4 and Kania-Richmond A5,6

1Schulich School of Dentistry and Medicine, Western University, London, ON, Canada

2School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada

3Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada

4Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

5Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada

6Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

*Corresponding author: Barton KI, Orthopaedic Surgery, Schulich School of Dentistry and Medicine, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada

Received: July 14, 2021; Accepted: August 31, 2021; Published: September 07, 2021


Almost half of patients referred to orthopedic surgeons for Total Joint Arthroplasty (TJA) do not require TJA at that time or are not appropriate surgical candidates. The objective was to explore patients’ perspectives of a Surgical Readiness Interview Tool and its potential utility in the Osteoarthritis (OA) management process. Semi-structured qualitative interviews were conducted with a convenience sample of patients from arthroplasty clinics in Alberta. All interviews were digitally recorded and transcribed verbatim. Analysis was conducted iteratively, applying a constant comparison method. Nine patients were interviewed. Participants found the interview tool to be relevant and comprehensible. Suggestions were made on how to improve tool clarity and administration processes. Patient orientation versus that of the doctor, and expectation management emerged as salient factors in the meaningful application of the tool. As a result of the interviews, a revised tool was developed which incorporated the participant suggestions. Patients were positive about the interview tool and felt that it would lead to better care provision, particularly with incorporation of participants’ suggestions. The data suggest that the interview tool could improve the conversation on surgical readiness, conservative management, and addressing modifiable risk factors prior to TJA.

Keywords: Osteoarthritis; Readiness; Arthroplasty; Motivational interviewing; Modifiable risk factors


BJH SCN: Bone and Joint Health Strategic Clinical Network; OA: Osteoarthritis; TJA: Total Joint Arthroplasty


Total Joint Arthroplasty (TJA) surgery is an effective and costeffective intervention for severe hip and knee Osteoarthritis (OA) leading to reduce pain, improve function, and improve quality of life [1-8]. In current practice, surgical suitability and medically determined readiness for TJA includes the following factors: degree of OA (progression of OA disease on plain radiographs), level of severity of functional disability or dysfunction, pain experience, patient symptoms, and/or co-morbidities, most notably obesity [9]. However, utilization rates vary, as there are no set indications for when it is best to operate, and which patients benefit most from the operation.

The majority of patients that are referred to orthopedic surgeons for hip and knee OA in Alberta do not require TJA at that time or are not appropriate surgical candidates. McHugh et al. report that patient referrals to an orthopedic surgeon by general practitioners were often inappropriate, with only 33% of referred patients undergoing TJA [10]. Of the remaining patients, the majority were sent back to their family physician because they did not want to undergo TJA or they had not yet exhausted non-surgical options (i.e. physiotherapy, joint injections, weight loss), had been referred to the wrong type of specialist (i.e. referred for arthroplasty when should have been referred high tibial osteotomy), or were not in a condition severe enough to warrant TJA [10]. Canadian data suggests that 45% of patients with moderate knee OA who are referred by their family physician to an orthopaedic surgeons do not require TJA at that time or are not appropriate surgical candidates [11,12]. Klett et al. [13] also found that 47.4% of patients referred to sports medicine specialists were referred back to their primary care physician. Furthermore, patients referred to TJA by a sport medicine specialist were more likely to have exhausted conservative measures to manage their OA [13], utilizing conservative management prior to TJA. Similarly, in a study by Cross et al. [14], orthopaedic surgeons were found to be focused on disease management (disease severity, obesity, severity, patient demand, nursing home residency, etc.) in comparison to referring health care providers, which suggests the importance surgeons place on exhausting conservative management before proceeding with TJA.

One proposed solution to address this important point was the development of a Surgical Readiness Interview Tool (interview tool) that would facilitate a conversation between a family physician and a patient about modifiable risk factors and non-surgical management strategies for OA. Further, there was no other screening tool used being used by family physicians prior to a referral for an orthopedic consult to evaluate readiness for TJA and to identify modifiable risk factors that may contribute to adverse surgical outcomes. Lastly, it was recognized that such an interview tool might also enable a supportive dialogue with a shift to emphasize non-surgical approaches, which would be more beneficial to the patients’ overall health.

The interview tool was developed by assessing the current evidence-based guidelines and recommendations for both TJA and optimizing surgical outcomes (Table 1). The language used was based on current Motivational Interviewing (MI) techniques and used to identify patient knowledge, engagement, and ability to change [15]. The interview tool also included evidence-based non-surgical management strategies to ensure patients are aware of and have exhausted all other treatment options prior to a consult for surgery.