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Characterizing Patient Preferences Surrounding Total Knee Arthroplasty

Reuter, John M., MS1; Hutyra, Carolyn A., BS2; Politzer, Cary S., BS2; Calixte, Christopher C., BS2; Scott, Daniel J., MD, MBA2; Attarian, David E., MD2; Mather, Richard C. III, MD, MBA2

doi: 10.2106/JBJS.OA.18.00017
Scientific Articles: PDF Only

Background: Episode-based bundled payments for total knee arthroplasty emphasize cost-effective patient-centered care. Understanding patients’ perceptions of components of the total knee arthroplasty care episode is critical to achieving this care. This study investigated patient preferences for components of the total knee arthroplasty care episode.

Methods: Best-worst scaling was used to analyze patient preferences for components of the total knee arthroplasty care episode. Participants were selected from patients presenting to 2 orthopaedic clinics with chronic knee pain. They were presented with descriptions of 17 attributes before completing a best-worst scaling exercise. Attribute importance was determined using hierarchical Bayesian estimation. Latent class analysis was used to evaluate varying preference profiles.

Results: One hundred and seventy-four patients completed the survey, and 117 patients (67%) were female. The mean age was 62.71 years. Participants placed the highest value on surgeon factors, including level of experience, satisfaction rating, and complication rates. Latent class analysis provided a 4-segment model of the population.

Conclusions: This study demonstrated differences in patient preferences for the components of a total knee arthroplasty care episode and characterized distinct preference profiles among patient subsets. Stakeholders can use this information to focus efforts and policy on high-value components and to potentially create customized bundles guided by preference profiles.

Clinical Relevance: This study is clinically relevant because the patient preferences identified here may help providers to design customized bundles for total knee arthroplasty care.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

1University of Rochester School of Medicine and Dentistry, Rochester, New York

2Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina

E-mail address for J.M. Reuter:

Investigation performed at the Duke University Health System, Durham, North Carolina, and EmergeOrtho, Durham, North Carolina

Disclosure: One author of this study (C.C.C.) received a grant from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number TL1TR001116. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

© 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Journal of Bone and Joint Surgery, Incorporated.