OBJECTIVE: to assess the proportion of participants reconsidering their willingness to undergo surgery after three and 12 months. Secondary aims are to analyse and compare the characteristics of people willing and unwilling to undergo joint surgery for osteoarthritis (OA) before a first-line intervention; to study the association between pain intensity, walking difficulties, self-efficacy and fear of movement with the willingness to undergo surgery.
DESIGN: This is an observational study based on Swedish register data. We included 30,578 people with knee or hip OA who participated in a first-line intervention including education and exercise.
RESULTS: People willing to undergo surgery at baseline showed a higher proportion of men (40% vs 27%) and more severe symptoms and disability. Respectively, 45% and 30% of the people with knee and hip OA who were willing to undergo surgery at baseline became unwilling after the intervention. At the end of the study period (12 months), 35% and 19% of those with knee and hip OA, respectively, who were willing to undergo surgery at baseline became unwilling. High pain intensity, walking difficulties, and fear of movement were associated with higher odds of being willing to undergo surgery at both follow-ups while increased self-efficacy showed the opposite association.
CONCLUSIONS: A first-line intervention for OA is associated with reduced willingness to undergo surgery with a greater proportion among knee OA than hip OA people. Due to its temporal variability, willingness to undergo surgery should be used with care to deem surgery eligibility.