• Brenda Iglesias, Hajun Jeong, Benjamin C Bengs, Don P Sanders, Nelson F SooHoo, and Rafael A Buerba.
• Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Room 76-143 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095 USA; Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059 USA.
• J Natl Med Assoc. 2022 Jan 1; 113 (6): 693-700.

IntroductionPrevious research has shown that patients from historically marginalized groups in the United States tend to have poorer outcomes after joint replacement surgery and that they are less likely to receive joint replacement surgery at high-volume hospitals. However, little is known regarding how this group of patients chooses their joint replacement surgeon. The purpose of this study was to understand the factors influencing the choice of joint replacement surgeon amongst a diverse group of patients.MethodsSemi-structured interviews were conducted with Medicare patients who underwent a hip or knee replacement within the last 24 months (N = 38) at an academic and community hospital. Interviews were audio recorded, transcribed and verified for accuracy. Transcripts were reviewed using iterative content analysis to extract key themes related to how respondents chose their joint replacement surgeon.Results And DiscussionMD referral/recommendation appears to be the strongest factor influencing joint replacement surgeon choice. Other key considerations are hospital reputation and surgeon attributes-including operative experience, communication skills, and participation in shared decision-making. Gender/ethnicity of a surgeon, industry payments to surgeons, number of publications and cost did not play a large role in surgeon choice.Conclusion And Clinical RelevanceThe process of choosing a joint replacement surgeon is a complex decision-making process with several factors at play. Despite growing availability of information regarding surgeons, patients largely relied on referrals for choosing their joint replacement surgeon regardless of ethnicity. Referring physicians need to ensure that patients are able to access hospital and surgeon outcomes, operative volume, and industry-payment information to learn more about their orthopedic surgeons in order to make an informed choice.Copyright © 2021 National Medical Association. Published by Elsevier Inc. All rights reserved.

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