OBJECTIVE: To determine factors associated with orthopaedic surgeons' decision to recommend total joint replacement (TJR) in people with knee and hip osteoarthritis (OA). DESIGN: Cross-sectional study in eleven countries. For consecutive outpatients with definite hip or knee OA consulting an orthopaedic surgeon, the surgeon's indication of TJR was collected, as well as patients' characteristics including comorbidities and social situation, OA symptom duration, pain, stiffness and function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), joint-specific quality of life, Osteoarthritis Research Society International (OARSI) joint space narrowing (JSN) radiographic grade (0-4), and surgeons' characteristics. Univariable and multivariable logistic regressions were performed to identify factors associated with the indication of TJR, adjusted by country. RESULTS: In total, 1905 patients were included: mean age was 66.5 (standard deviation [SD], 10.8) years, 1082 (58.0%) were women, mean OA symptom duration was 5.0 (SD 7.0) years. TJR was recommended in 561/1127 (49.8%) knee OA and 542/778 (69.7%) hip OA patients. In multivariable analysis on 516 patients with complete data, the variables associated with TJR indication were radiographic grade (Odds Ratio, OR for one grade increase, for knee and hip OA, respectively: 2.90, 95% confidence interval [1.69-4.97] and 3.30 [2.17-5.03]) and WOMAC total score (OR for 10 points increase: 1.65 [1.32-2.06] and 1.38 [1.15-1.66], respectively). After excluding radiographic grade from the analyses, on 1265 patients, greater WOMAC total score was the main predictor for knee and hip OA; older age was also significant for knee OA. CONCLUSION: Radiographic severity and patient-reported pain and function play a major role in surgeons' recommendation for TJR.

Department of Clinical Sciences Lund Orthopaedics Lund University Lund Sweden

Department of Rheumatology Dijon University Hospital Dijon F 21078 France; INSERM U1093 University of Burgundy Dijon F 21079 France

Department of Rheumatology Leiden University Medical Center Leiden The Netherlands; Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands

Division of Health Care and Outcomes Research Krembil Research Institute Toronto Ontario Canada; Department of Rehabilitation Science and Health Policy University of Toronto Canada; Department of Management and Evaluation University of Toronto Canada

Division of Orthopaedic Surgery Toronto Western Hospital University of Toronto Arthritis Program University Health Network Toronto Canada

Division of Rheumatology and Clinical Immunology Department of Medicine and Division of Gerontology Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore MD USA

Division of Rheumatology Department of Medicine Women's College Hospital Women's College Research Institute Canada; Faculty of Medicine Institute of Health Policy Management and Evaluation Dalla Lana School of Public Health University of Toronto Canada

Institute of Bone and Joint Research University of Sydney Royal North Shore Hospital St Leonards Australia

Institute of Rheumatology Charles University Prague Czech Republic

Institute of Sports and Clinical Biomechanics University of Southern Denmark Denmark

Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds NIHR Leeds Biomedical Research Centre Leeds United Kingdom

Paris Descartes University Department of Rheumatology Hôpital Cochin APHP INSERM Clinical epidemiology and biostatistics PRES Sorbonne Paris Cité Paris 14 France

Rheumatology Unit Department of Medicine DIMED University of Padova Italy

Section of Rheumatology and Clinical Immunology University of Texas M D Anderson Cancer Center Houston TX USA

Sorbonne Universités UPMC Univ Paris 06 Institut Pierre Louis d'Epidémiologie et de Santé Publique Paris France; Rheumatology Department Hôpital Pitié Salpêtrière AP HP PARIS France

University Center of Orthopaedics and Traumatology Technische Universität Dresden Germany

University Hospital Bristol NHS Foundation Trust Bristol UK; Birmingham VA Medical Center University of Alabama Birmingham AL USA

University of Melbourne Department of Medicine Dept of Rheumatology Western Health Australian Institute of Musculoskeletal Science Melbourne Australia

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