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Limiting Factors for Indication of Hip and Knee Arthroplasty in Chile: The International Perception of Risk
Pedro Osorio1, Diego Amenábar1, Matías Salineros1
1Department of Orthopaedic Surgery, Clínica Universidad de los Andes, Santiago, Chile.
Insights
Chilean surgeons limit total hip (THA) and knee arthroplasty (TKA) based on medical factors like obesity and diabetes. Socioeconomic status also influences decisions, impacting perceived patient outcomes.
Area of Science:
- Orthopedics and Traumatology
- Public Health
- Health Economics
Background:
- Aging populations globally drive increased demand for total hip (THA) and knee arthroplasty (TKA).
- Osteoarthritis incidence rises with age, necessitating joint replacement surgeries.
- Understanding surgeon decision-making for THA/TKA indications is crucial.
Purpose of the Study:
- To investigate medical and social risk factors influencing Chilean orthopaedic surgeons' THA/TKA indication decisions.
- To identify key considerations beyond clinical necessity in arthroplasty referrals.
Main Methods:
- Anonymous survey distributed to 165 Chilean hip and knee arthroplasty surgeons.
- Response rate of 78% (128 surgeons) achieved.
- Questionnaire covered demographics, practice setting, and medical/socioeconomic factors impacting surgical indications.
Main Results:
- High body mass index (81%) and elevated hemoglobin A1c (92%) were significant limitations for elective THA/TKA.
- Lack of social support (58%) and low socioeconomic status (40%) also influenced indications.
- Most surgeons based decisions on personal experience/literature, not institutional pressure.
Conclusions:
- Modifiable medical factors (obesity, uncompensated diabetes) are primary limitations for THA/TKA in Chile.
- Surgeons aim to optimize clinical outcomes by limiting surgery in high-risk patients.
- Low socioeconomic status is perceived by 40% of surgeons to negatively affect patient outcomes.
Background:
An aging population with a resultant higher incidence of osteoarthritis have increased the need for total hip (THA) and knee arthroplasty (TKA) worldwide. The purpose of this study was to explore what medical and social risk factors are considered relevant by Chilean orthopaedic surgeons in decisions regarding indications for THA or TKA.
Methods:
An anonymous survey was sent to 165 hip and knee arthroplasty surgeons who were members of the Chilean Orthopedics and Traumatology Society. From a total of 165 surgeons, 128 (78%) completed the survey. The questionnaire included demographic data, place of work, and inquired about medical and socioeconomic factors that could affect surgical indications.
Results:
Factors that limited indications for elective THA/TKA included body mass index (81%), elevated hemoglobin A1c (92%), lack of social support network (58%), and low socioeconomic status (40%). Most respondents made decisions based on personal experience or literature review rather than hospital or departmental pressures. Of the respondents, 64% believe that some patient populations would benefit from better care if payment systems adjusted for their socioeconomic risk factors.
Conclusion:
In Chile, limitations regarding the indication for THA/TKA are most influenced by the presence of modifiable medical risk factors such as obesity, uncompensated diabetes, or malnutrition. We believe that the reason surgeons limit surgeries for such individuals is to promote better clinical outcomes, and not in response to pressure from paying entities. However, low socioeconomic status was perceived to impair the ability to achieve good clinical outcomes by 40% of the surgeons.
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