Opinions among Danish knee surgeons about indications to perform total knee replacement showed considerable variation

During the past decade, the incidence of primary total knee replacement (TKA) surgery in Denmark has approximately doubled. This increase could be due to weakened indications to perform TKA surgery. We aimed to investigate variation in opinions about indications to perform TKA among Danish knee surgeons.

In October 2011, a survey among Danish knee surgeons was performed at the Annual Meeting of the Danish Orthopaedic Society. A questionnaire targeting knee surgeons' opinion on indications for primary TKA was distributed. Questions concerned opinions on aspects of pain, body mass index (BMI), exercise, function, age, clinical and radiographic findings, and specific patient cases.

A total of 41 questionnaires were returned. Twenty-three knee surgeons performed > 100 TKAs annually. Opinions about the duration of knee pain and pain treatment, preoperative weight loss and exercise, excessive BMI as a contraindication, low age as a contraindication, and some of the specific patient cases demonstrated considerable variation. A statistically significantly higher proportion of high-volume versus low-volume knee surgeons did not find that BMI could be a contraindication to proceed with TKA surgery (p = 0.02).

Opinions among knee surgeons about indications to perform TKA showed considerable variation. The majority of the variation observed is tolerable and may be explained by lack of evidence or diverging literature reports. However, variation in opinions regarding preoperative weight loss and exercise may warrant the introduction of further guidelines for involved care takers.

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