• Jörg Lützner, Stefanie Deckert, Franziska Beyer, Waldemar Hahn, Jürgen Malzahn, Martin Sedlmayr, Klaus-Peter Günther, Jochen Schmitt, Toni Lange, and Value-based Total Knee Replacement Study Group.
• University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany; Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany; Institute for Medical Informatics and Biometry, University Hospital and Faculty of Medicine Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany; AOK Federal Association.
• Dtsch Arztebl Int. 2024 Aug 23; 121 (17): 566572566-572.

BackgroundWe studied whether an individualized digital decision aid can improve decision-making quality for or against knee arthroplasty.MethodsAn app-based decision aid (EKIT tool) was developed and studied in a stepped-wedge, cluster-randomized trial. Consecutive patients with knee osteoarthritis who were candidates for knee replacement were included in 10 centers in Germany. All subjects were asked via app on a tablet about their symptoms, prior treatments, and preferences and goals for treatment. For the subjects in the intervention group, the EKIT tool was used in the doctor-patient discussion to visualize the individual disease burden and degree of fulfillment of the indication criteria, and structured information on knee arthroplasty was provided. In the control group, the discussion was conducted without the EKIT tool in accordance with the local standard in each participating center. The primary endpoint was the quality of the patient's decision on the basis of the discussion of indications, as measured with the Hip and Knee Quality Decision Instrument (HK-DQI). (Registration number: ClinicalTrials.gov:NCT04837053).Results1092 patients were included, and data from 1055 patients were analyzed (616 in the intervention group and 439 in the control group). Good decision quality, as rated by the HKDQI, was achieved by 86.0% of patients in the intervention group and 67.4% of patients in the control group (relative risk, 1.24; 95 % confidence interval, [1.15; 1.33]).ConclusionA digital decision aid significantly improved the quality of decision-making for or against knee replacement surgery. The widespread use of this instrument may have an even larger effect, as this trial was conducted mainly in hospitals with high case numbers.

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