Orthopaedic Consultation is Associated With Fewer Patient-Perceived Barriers to Total Joint Arthroplasty

Abstract

Background

Orthopaedic consultations' influence on perceived barriers to total joint arthroplasty (TJA) remains unclear. This study explores how orthopedic consultations are associated with patient perceptions of barriers to TJA.

Methods

We performed a post-hoc analysis of questionnaire responses based on data from a previous study that used semi-structured interviews with patients with advanced osteoarthritis. This earlier study identified 5 key barriers to TJA—trust in surgeon, cost/insurance, recovery, surgical outcome, and timing of surgery—and highlighted significant racial differences in these barriers. Our analysis focused specifically on the role of orthopaedic consultations. Using multiple logistic regression models, we compared responses from patients who had an orthopaedic consultation to those who did not, while adjusting for race, age, Hip Disability and Osteoarthritis Outcome Score, Joint Replacement/Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, insurance status, education level, and prior discussions about TJA.

Results

Of the 696 participants, 88% were female, 77% White, 11% Black, and 9% Hispanic. Nearly half (49%) had an orthopaedic consultation. Participants who had consulted with an orthopaedist were older, more likely to be college graduates, Medicare beneficiaries, have consulted a primary care physician, attempted conservative management including joint injections, braces, and physical therapy. After adjusting for participant factors, orthopaedic consultation was a predictor of fewer perceived cost/insurance and timing barriers. However, no differences were observed in other barriers.

Conclusions

Orthopaedic consultation is associated with fewer reported cost/insurance and timing barriers to TJA. Addressing barriers of concern to patients in the context of orthopaedic consultations could further improve TJA utilization.