Purpose: The utility of decision aids and the shared decision making process has been demonstrated in numerous disciplines, and has been shown to be beneficial in scenarios such as cancer screening and treatment selection. To our knowledge, a shared decision model has yet to be tested in the setting of elective knee replacement surgery, where patients with degenerative and usually painful joints must decide whether to proceed with surgery or medical management.

Methods: Patients deemed by their surgeon to be candidates for total knee replacement were randomized into two groups. Group 1 was offered a decision aid video describing treatment options for advanced knee osteoarthritis, including both non-surgical and surgical management. Group 2 was only offered a brochure describing only knee replacement, even though non-surgical options were discussed by each patient's orthopaedic surgeon. Patients had the option to decline decision aids. Survey measures including SF-36, WOMAC, Knee Society Score, decisional distress, comparison of expected and actual outcomes, and level of satisfaction were assessed at baseline and after the shared decision making process.

Results: Integration of a shared decision making process into care of patients with knee arthritis is possible and does not adversely affect clinic throughput. Patients appreciate the opportunity to review additional material about their treatment choices. Several benchmarks indicate that decision support has successfully been integrated into osteoarthritis treatment, including enhanced patient comprehension of key points of the surgical procedure, decreased decisional conflict, and minimization of decisional regret at the completion of follow-up. Examination of key demographic indicators may reveal segments of the knee arthritis patient population that may benefit from decision aids prior to deciding on treatment for knee osteoarthritis.

Conclusions: Outcomes of implementing shared decision making into knee arthritis treatment include an improvement in patient comprehension of available treatment options, resulting in decreased decisional conflict during the decision making process. Both clinicians and patients stand to derive significant benefits when faced with total knee replacement as a treatment option for osteoarthritis.