ArticleBMC musculoskeletal disorders2021
Effects of a medical second opinion programme on patients' decision for or against knee arthroplasty and their satisfaction with the programme.
Article in BMC musculoskeletal disorders, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 16 citations in OpenAlex.
- Evidence-based informed consent forms for total knee arthroplasty and anaesthesia: development and pilot study.Journal of orthopaedic surgery and research · 2026Article
- Mapping the Quality of German-Language Health Information on the Treatment of Knee Osteoarthritis: Cross-Sectional Analysis.JMIR infodemiology · 2025Article
- "Diagnostic pathways in femoroacetabular impingement, patterns of clinical visits, and MRI utilization before hip arthroscopy in Türkiye".Scientific reports · 2025Article
- Exploring heterogeneity in coxarthrosis medication use patterns before total hip replacement: a State Sequence Analysis.BMJ open · 2024Article
- Second opinion and time to knee arthroplasty: a prospective cohort study of 142 patients.BMJ open · 2023Article
- Informed consent for total knee arthroplasty: exploration of patient`s information acquisition and decision-making processes-a qualitative study.BMC health services research · 2023Article
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGerman social legislation gives patients the right to obtain a second opinion before elective surgery and defines quality criteria for reimbursement by statutory health insurances. However, the effects of second opinions before elective surgery are largely unknown. The aim of this study was to evaluate the effects of a second opinion programme in patients recommended for knee arthroplasty.
methodsThe largest statutory health insurance funds in Bavaria offered patients who had been recommended to have knee arthroplasty the opportunity to partake in a second opinion programme which consisted of an in person presentation to an experienced knee surgeon. In this cohort study, consecutive patients from this second opinion programme who signed informed consent were included from 07/10/2016 to 14/02/2020. Data were collected before and after the second opinion visit.
resultsA total of 141 (66%) of 215 patients who presented for a second opinion participated in the evaluation study. The second opinion physician recommended knee arthroplasty to 40% of the patients, later knee arthroplasty if the conditions worsened to 40%, and no knee arthroplasty to 20%. After receiving the second opinion 28 of 56 (41%) undecided patients preferred knee arthroplasty, 14 no knee arthroplasty, 14 remained undecided. Four of 46 patients with a preference for "arthroplasty" changed their decision to "no arthroplasty", five of 35 patients from "no arthroplasty" to "arthroplasty". The patients were more confident in their decision according to the decision confidence scale (before: 5.4 ± 3.0; after: 7.8 ± 2.5; p < 0.001). They rated their satisfaction with the second opinion programme with a mean grade of 1.35 (± 0.60) (best:1; worst:6). Logistic regression analyses showed that the recommendation of the second opinion physician for joint arthroplasty was associated with the guideline criteria radiological severity of osteoarthritis (p = 0.001) and knee-joint-specific quality of life (p = 0.041).
conclusionThe second opinion of an experienced knee surgeon frequently deviates from the initial recommendation for knee arthroplasty. The association of guideline criteria to the second recommendation suggests a high quality of the second opinion. From the patient perspective, the second opinion reduces uncertainties in their treatment decision.
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