Shared Decision-Making in Total Hip and Knee Arthroplasty
Bibliographic record
Abstract
BACKGROUND: Although total hip and total knee arthroplasty are highly successful operations, the decision of whether and when to undergo surgery is highly subjective and discretionary, and specific guidelines regarding readiness for surgery remain elusive. The nature of these decisions underscores the importance of shared decision-making, which is founded on the concept that patients substantially contribute to determining their own readiness for surgery. The OPTION survey was developed as a conversation aid to facilitate shared decision-making in the context of total joint arthroplasty. METHODS: The OPTION survey was created in partnership with a panel of 10 active joint replacement patients and 15 arthroplasty surgeons, using a modified Delphi methodology that employed 3 sequential meetings by each group. The survey interrogates patient and surgeon ratings of pain, activity limitation, duration of treatment, prior treatments, and quality of life; patient-rated treatment priorities, readiness for surgery, and surgeon engagement; and surgeon-graded radiographic disease. The survey was administered as an institutional review board-approved pilot during 641 patient-clinician encounters for hip or knee arthritis at 9 U.S. sites, and was independently completed by the patient and surgeon. RESULTS: Patient self-assessment of readiness for surgery includes consideration of existing functional impairment, outcome priorities, realistic expectations, and personal socioeconomic circumstances. Patients most commonly ranked removal of activity limitations as their top treatment priority, while alleviation of pain and avoidance of a long recovery were also ranked highly. Mild and severe pain were associated with similar radiographic disease severity, and worsening radiographic disease was associated with increasing patient-reported readiness for surgery. Patients and surgeons agreed on symptom severity in >90% of cases. When disagreement occurred, surgeons typically underestimated patient-reported symptoms; these cases were associated with lower patient-rated surgeon engagement in shared decision-making conversations. CONCLUSIONS: Shared decision-making conversations substantially contributed to the assessment of patient readiness for joint replacement surgery. When patient and surgeon assessments were not aligned, surgeons most commonly underestimated patient-perceived impairment. These observations should inform optimal surgeon-patient communications. LEVEL OF EVIDENCE: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.083 | 0.136 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.005 | 0.008 |
| Scholarly communication | 0.006 | 0.004 |
| Open science | 0.002 | 0.011 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".