The Choice Between Total Hip Arthroplasty and Arthrodesis in Adolescent Patients: A Survey of Orthopedic Surgeons.

For adolescent patients with end-stage hip disease, the choice between total hip arthroplasty (THA) and arthrodesis is complex; the clinical evidence is not definitive, and there are difficult trade-offs between clear short-term benefits from THA and uncertain long-term risks. We surveyed nearly 700 members of the Pediatric Orthopedic Society of North America and the American Association of Hip and Knee Surgeons. Respondents chose between a recommendation of THA or arthrodesis in four clinical vignettes. A clear majority of surgeons recommended THA in two of the vignettes, however opinion was somewhat divided in one vignette (overweight adolescent) and deeply divided in another (adolescent destined for manual labor job). Across all vignettes, recommendations varied systematically according to surgeons' age and their attitudes regarding tradeoffs between life stages.

Surgeon age as the major factor in recommendation of uni-compartmental knee replacement versus high tibial osteotomy: a case study in orthopaedic decision making.

This case report concerns surgical decision making. The subject is a 59 year old male orthopaedic surgeon with medial compartment knee arthritis. Both high tibial valgus osteotomy and uni-compartmental knee replacement would be appropriate with similar outcomes reported in the literature. Surprisingly, almost all young surgeons recommended a uni-compartmental knee replacement and almost all older surgeons recommended a high tibial osteotomy. We discuss the reasons that surgeon age, which is clearly irrelevant to the optimal decision, is the dominant determinant of surgical recommendation for this patient.