Patient Centeredness in Total Joint Replacement

Patient-centered care (PCC) is gaining considerable momentum among health care professionals and policy-making authorities. The need for PCC stems from the innumerable benefits of adopting such a system. The practice of PCC in orthopedic surgery in general, and in total joint replacement in particular, is still in its youth. However, present literature already establishes the need for applying PCC in total joint replacement. Extensive research and effort should be invested to better grasp and define the dimensions of PCC as they relate to total joint replacement.

  • The benefits of PCC necessitates that the practice start sooner rather than later, and that governmental agencies, institutions, and various stakeholders invest in setting up dedicated centers to that end.

  • The benefits of PCC necessitates that the practice start sooner rather than later, and that governmental agencies, institutions, and various stakeholders invest in setting up dedicated centers to that end.

  • Communication requires the combined efforts and active participation of the patient, PCP, surgeon, family, administrators, and anyone involved in the health care system ( Fig. 1 ). Even though communication should always cover the essentials of informed consent (diagnosis, prognosis, alternatives), it should also include the patient’s expectations, needs, perspectives, social values, and other aspects of care. Communication involves educating the patient and also serves as an educational process to the surgeon and the PCP to treat the patient rather than the disease. Finally, the gap in communication between PCP and orthopedic surgeons should also be filled to avoid delay in patient care. To that end, the health care system should invest in centers dedicated to PCC. These centers should tie together the different variables in this complex equation. It should also oversee and guide the communication needed, by the different technologies at hand, in a coherent integrated flow that is evidence-based and patient-centered.

    Fig. 1

    Communication in a patient-centered setting.


    1. 1. Epstein R.M., and Street R.L.: The values and value of patient-centered care. Ann Fam Med 2011; 9: pp. 100-103

    2. 2. Sia C., Tonniges T.F., Osterhus E., et al: History of the medical home concept. Pediatrics 2004; 113: pp. 1473-1478

    3. 3. Saha S., Beach M.C., and Cooper L.A.: Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc 2008; 100: pp. 1275-1285

    4. 4. Barry M.J., and Edgman-Levitan S.: Shared decision making–pinnacle of patient-centered care. N Engl J Med 2012; 366: pp. 780-781

    5. 5. Conway J, Johnson B, Edgman-Levitan S, et al. Partnering with patients and families to design a patient- and family-centered health care system: background paper for invitational meeting of patient-centered care leaders. Massachusetts, June 2, 2006.

    6. 6. Heidenreich P.A.: Time for a thorough evaluation of patient-centered care. Circ Cardiovasc Qual Outcomes 2013; 6: pp. 2-4

    7. 7. El Miedany Y.: Adopting patient-centered care in standard practice: PROMs moving toward disease-specific era. Clin Exp Rheumatol 2014; 32: pp. S-40-S-46

    8. 8. Institute of Medicine : Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press, 2001.

    9. 9. Mandl L.A.: Determining who should be referred for total hip and knee replacements. Nat Rev Rheumatol 2013; 9: pp. 351-357

    10. 10. Losina E., Walensky R.P., Kessler C.L., et al: Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med 2009; 169: pp. 1113-1121

    11. 11. Kurtz S., Ong K., Lau E., et al: Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89: pp. 780-785

    12. 12. Institute of Medicine : Envisioning the national health care quality report. Washington, DC: National Academies Press, 2001.

    13. 13. Farley F.A.: The case for patient-centered care in orthopaedics. J Am Acad Orthop Surg 2006; 14: pp. 447-451

    14. 14. Available at: Accessed September 10, 2015.

    15. 15. Shaller D. Patient-centered care: what does it take?. Shaller Consulting. 2007. Available at:–what-does-it-take. Accessed September 10, 2015.

    16. 16. Available at: Accessed September 10, 2015.

    17. 17. Ontario Medical Association : OMA policy on patient-centred care. Ont Med Rev 2010; undefined: pp. 34-49

    18. 18. Declaration on Patient-Centred Healthcare : What is patient-centred healthcare?: a review of definitions and principles. London: IAPO, 2005.

    19. 19. Available at: Accessed September 10, 2015.

    20. 20. Cronin C. “Patient-centered care: an overview of definitions and concepts,” prepared for the National Health Council. 2004.

    21. 21. Stewart M., Brown J.B., Donner A., et al: The impact of patient-centered care on outcomes. J Fam Pract 2000 Sep; 49: pp. 796-804

    22. 22. Anderson E.B.: Patient-centeredness: a new approach. Nephrol News Issues 2002; 16: pp. 80-82

    23. 23. Michie S., Miles J., and Weinman J.: Patient-centeredness in chronic illness: what is it and does it matter? Patient Educ Couns 2003; 51: pp. 197-206

    24. 24. Little P., Everitt H., Williamson I., et al: Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 2001; 323: pp. 908-911

    25. 25. DiMatteo M.R.: The role of the physician in the emerging health care environment. West J Med 1998; 168: pp. 328-333

    26. 26. Beck R.S., Daughtridge R., and Sloane P.D.: Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract 2002; 15: pp. 25-38

    27. 27. Rhoades D.R., McFarland K.F., Finch W.H., et al: Speaking and interruptions during primary care office visits. Fam Med 2001; 33: pp. 528-532

    28. 28. Berry L.L., Seiders K., and Wilder S.S.: Innovations in access to care: a patient-centered approach. Ann Intern Med 2003; 139: pp. 568-574

    29. 29. Bechel D.L., Myers W.A., and Smith D.G.: Does patient-centered care pay off? Jt Comm J Qual Improv 2000; 26: pp. 400-409

    30. 30. Saha S., and Beach M.C.: The impact of patient-centered communication on patients’ decision making and evaluations of physicians: a randomized study using video vignettes. Patient Educ Couns 2011; 84: pp. 386-392

    31. 31. Kim S.S., Kaplowitz S., and Johnston M.V.: The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof 2004; 27: pp. 237-251

    32. 32. Prueksaritanond S., Tubtimtes S., Asavanich K., et al: Type 2 diabetic patient-centered care. J Med Assoc Thai 2004; 87: pp. 345-352

    33. 33. Bertakis K.D., and Azari R.: Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med 2011; 24: pp. 229-239

    34. 34. Lane-Carlson M.L., and Kumar J.: Engaging patients in managing their health care: patient perceptions of the effect of a total joint replacement presurgical class. Perm J 2012; 16: pp. 42-47

    35. 35. Franklin P.D., Allison J.J., and Ayers D.C.: Beyond joint implant registries: a patient-centered research consortium for comparative effectiveness in total joint replacement. JAMA 2012; 308: pp. 1217-1218

    36. 36. Franklin P.D., Lewallen D., Bozic K., et al: Implementation of patient-reported outcome measures in U.S. Total joint replacement registries: rationale, status, and plans. J Bone Joint Surg Am 2014; 96: pp. 104-109

    37. 37. Van Citters A.D., Fahlman C., Goldmann D.A., et al: Developing a pathway for high-value, patient-centered total joint arthroplasty. Clin Orthop Relat Res 2014; 472: pp. 1619-1635

    38. 38. Rathert C., Wyrwich M.D., and Boren S.A.: Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev 2013; 70: pp. 351-379

    39. 39. Morris BJ, Jahangir AA, Sethi MK. Patient satisfaction: an emerging health policy issue. What the orthopaedic surgeon needs to know. Available at: Accessed October 10, 2015.

    40. 40. Pascoe G.C.: Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann 1983; 6: pp. 185-210

    41. 41. Chow A., Mayer E.K., Darzi A.W., et al: Patient-reported outcome measures: the importance of patient satisfaction in surgery. Surgery 2009; 146: pp. 435-443

    42. 42. Bourne R.B., Chesworth B.M., Davis A.M., et al: Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 2010; 468: pp. 57-63

    43. 43. Anderson J.G., Wixson R.L., Tsai D., et al: Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthroplasty 1996; 11: pp. 831-840

    44. 44. Noble P.C., Conditt M.A., Cook K.F., et al: The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 2006; 452: pp. 35-43

    45. 45. Hawker G., Wright J., Coyte P., et al: Health-related quality of life after knee replacement. Results of the knee replacement patient outcomes research team study. J Bone Joint Surg Am 1998; 80: pp. 163-173

    46. 46. Heck D.A., Robinson R.L., Partridge C.M., et al: Patient outcomes after knee replacement. Clin Orthop Relat Res 1998; 356: pp. 93-110

    47. 47. Robertsson O., Dunbar M., Pehrsson T., et al: Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 2000; 71: pp. 262-267

    48. 48. Wylde V., Learmonth I., Potter A., et al: Patient reported outcomes after fixed- versus mobile-bearing total knee replacement: a multi-centre randomised controlled trial using the Kinemax total knee replacement. J Bone Joint Surg Br 2008; 90: pp. 1172-1179

    49. 49. Guldvog B.: Can patient satisfaction improve health among patients with angina pectoris? Int J Qual Health Care 1999; 11: pp. 233-240

    50. 50. Donabedian A.: The quality of care. How can it be assessed? JAMA 1988; 260: pp. 1743-1748

    51. 51. Marquis M.S., Davies A.R., and Ware J.E.: Patient satisfaction and change in medical care provider: a longitudinal study. Med Care 1983; 21: pp. 821-829

    52. 52. Ha J.F., and Longnecker N.: Doctor-patient communication: a review. Ochsner J 2010; 10: pp. 38-43

    53. 53. Asadi-Lari M., Tamburini M., and Gray D.: Patients’ needs, satisfaction, and health related quality of life: towards a comprehensive model. Health Qual Life Outcomes 2004; 2: pp. 32

    54. 54. Graham B., Green A., James M., et al: Measuring patient satisfaction in orthopaedic surgery. J Bone Joint Surg Am 2015; 97: pp. 80-84

    55. 55. Judge A., Arden N.K., Price A., et al: Assessing patients for joint replacement: can pre-operative Oxford hip and knee scores be used to predict patient satisfaction following joint replacement surgery and to guide patient selection? J Bone Joint Surg Br 2011; 93: pp. 1660-1664

    56. 56. Saleh K.J., Bershadsky B., Cheng E., et al: Lessons learned from the hip and knee musculoskeletal outcomes data evaluation and management system. Clin Orthop Relat Res 2004; 429: pp. 272-278

    57. 57. Available at: Accessed October 15, 2015.

    58. 58. Murray D.W., Fitzpatrick R., Rogers K., et al: The use of the Oxford hip and knee scores. J Bone Joint Surg Br 2007; 89: pp. 1010-1014

    59. 59. Middleton S., Gattellari M., Harris J.P., et al: Assessing surgeons’ disclosure of risk information before carotid endarterectomy. ANZ J Surg 2006; 76: pp. 618-624

    60. 60. Arora N.: Interacting with cancer patients: the significance of physicians’ communication behavior. Soc Sci Med 2003; 57: pp. 791-806

    61. 61. Bredart A., Bouleuc C., and Dolbeault S.: Doctor-patient communication and satisfaction with care in oncology. Curr Opin Oncol 2005; 17: pp. 351-354

    62. 62. Dorr L.D., and Chao L.: The emotional state of the patient after total hip and knee arthroplasty. Clin Orthop Relat Res 2007; 463: pp. 7-12

    63. 63. Braddock C.H., Edwards K.A., Hasenberg N.M., et al: Informed decision making in outpatient practice: time to get back to basics. JAMA 1999; 282: pp. 2313-2320

    64. 64. Tongue J.R., Epps H.R., and Forese L.L.: Communication skills for patient-centered care: research-based, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients. J Bone Joint Surg Am 2005; 87: pp. 652-658

    65. 65. Figaro M.K., Williams-Russo P., and Allegrante J.P.: Expectation and outlook: the impact of patient preference on arthritis care among African Americans. J Ambul Care Manage 2005; 28: pp. 41-48

    66. 66. Trousdale R.T., McGrory B.J., Berry D.J., et al: Patients’ concerns prior to undergoing total hip and total knee arthroplasty. Mayo Clin Proc 1999; 74: pp. 978-982

    67. 67. Wright J.G., Rudicel S., and Feinstein A.R.: Ask patients what they want: evaluation of individual complaints before total hip replacement. J Bone Joint Surg Br 1994; 76: pp. 229-234

    68. 68. Wiklunch I., and Romanus B.: A comparison of quality of life before and after arthroplasty in paitents who had arthrosis of the hip joint. J Bone Joint Surg Am 1991; 73A: pp. 765-769

    69. 69. Schonberg M.A., Edward M.R., and Hamel M.B.: Perceptions of physician recommendations for joint replacement surgery by older patients with severe hip or knee osteoarthritis. J Am Geriatr Soc 2009; 57: pp. 82-88

    70. 70. Ang D.C., Thomas K., and Kroenke K.: An exploratory study of primary care physician decision making regarding total joint arthroplasty. J Gen Intern Med 2007; 22: pp. 74-79

    71. 71. Moreno B.A.C., and Arteaga G.M.G.: Violation of ethical principles in clinical research. Influences and possible solutions for Latin America. BMC Med Ethics 2012; 13: pp. 35

    72. 72. Eddy D.M.: Designing a practice policy: standards, guidelines, and options. JAMA 1990; 263: pp. 3077-3084

    73. 73. Charles C., Gafni A., and Whelan T.: Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44: pp. 681-692

    74. 74. Fowler F.J., Levin C.A., and Sepucha K.R.: Informing and involving patients to improve the quality of medical decisions. Health Aff (Millwood) 2011; 30: pp. 699-706

    75. 75. Rodriguez-Osorio C.A., and Dominguez-Cherit G.: Medical decision making: paternalism versus patient-centered (autonomous) care. Curr Opin Crit Care 2008; 14: pp. 708-713

    76. 76. Stacey D., Légaré F., Col N.F., et al: Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2014; undefined:

    77. 77. Kaplan S.H., Greenfield S., Gandek B., et al: Characteristics of physicians with participatory decision-making styles. Ann Intern Med 1996; 124: pp. 497-504

    78. 78. Page AE, Moulton B. Shared decision making in orthopaedics. Available at: Accessed October 10, 2015.

    79. 79. Slover J., Shue J., and Koenig K.: Shared decision-making in orthopaedic surgery. Clin Orthop Relat Res 2012; 470: pp. 1046-1053

    80. 80. Bozic K.J., Belkora J., Chan V., et al: Shared decision making in patients with osteoarthritis of the hip and knee: results of a randomized controlled trial. J Bone Joint Surg Am 2013; 95: pp. 1633-1639

    81. 81. Arterburn D., Wellman R., Westbrook E., et al: Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs. Health Aff (Millwood) 2012; 31: pp. 2094-2104

    82. 82. Tzeng A., Tzeng T., Vasdev S., et al: The role of patient activation in achieving better outcomes and cost-effectiveness in patient care. J Bone Joint Surg Rev 2015; 3: pp. e4

    83. 83. Hibbard J.H., Mahoney E.R., Stockard J., et al: Development and testing of a short form of the patient activation measure. Health Serv Res 2005; 40: pp. 1918-1930

    84. 84. Skolasky R.L., Mackenzie E.J., Wegener S.T., et al: Patient activation and functional recovery in persons undergoing spine surgery. J Bone Joint Surg Am 2011; 93: pp. 1665-1671

    85. 85. Pellino T., Tluczek A., Collins M., et al: Increasing self-efficacy through empowerment: preoperative education for orthopaedic patients. Orthopaedic Nurs 1998; 17: pp. 48-59

    86. 86. Von Korff M., Moore J.E., Lorig K., et al: A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care. Spine 1998; 23: pp. 2608-2615

    87. 87. DiGioia A., Greenhouse P.K., and Levison T.J.: Patient and family-centered collaborative care an orthopaedic model. Clin Orthop Relat Res 2007; 463: pp. 13-19

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    Feb 23, 2017 | Posted by in ORTHOPEDIC | Comments Off on Patient Centeredness in Total Joint Replacement

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