Shared Decision Making in Total Hip and Knee Replacement

Shared Decision Making in Total Hip and Knee Replacement

By William P Barrett, MD

In shared decision-making, patients and physicians make contributions to the dialogue about a patient’s condition, the best way to achieve the optimal outcome, and treatment options. The surgeon contributes expert clinical knowledge about the condition, the natural history of the condition, the treatment options available with associated risks and benefits and the limitations of currently available evidence. The patient contributes to the dialogue their goals and expectations, what their personal preferences are with regard to their treatment options, and what they value. There are a variety of ways that this dialogue can be fostered, and these include patient handouts, web-based information, and other means of information dissemination. The more informed the patient is regarding their condition and treatment options the more likely they will be able to make a rational decision about proceeding with a specific treatment. We encourage patients to come with questions regarding their condition, treatment options, and to think about what it is they hope to achieve after a particular treatment. The ability to align the results of joint replacement with the expectations of the patient has a greater likelihood of leading to a happier patient after surgery.  Once a decision is reached to proceed with a surgical intervention, it is up to the patient along with the assistance of the physician to optimize their health so as to minimize the risks associated with the procedure. There is no treatment that is risk free, but optimizing one’s health and physical conditioning prior to having surgery, which includes attention to weight, treatment of various medical conditions, smoking cessation, and improvement in strength will help decrease the risk of a complication following surgery.

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