OBJECTIVES : Although total knee arthroplasty (TKA) is commonly used for end-stage osteoarthritis of the knee, up to 20% of patients are dissatisfied with their outcomes. TKA is associated with increased complication rates compared to unicompartmental knee arthroplasty (UKA). With UKA, patients can have better functional outcomes, but the surgery is associated with a higher risk of revision. Recent studies have suggested that a patient-centric approach is essential to improve patient satisfaction with surgery, but no study has formally evaluated patient preferences between outcomes of TKA and UKA.

METHODS : A discrete-choice experiment (DCE) was administered to patients with knee osteoarthritis between the ages of 40 and 80. The DCE included the following attributes: chance of complications within 3 months of operation, functional ability after recovery, awareness of the knee implant after recovery, and chance of needing another operation within 10 years. Respondents completed one of two versions of the instrument based on their self-reported functional ability as measured by the Oxford Knee Score. Each version evaluated preferences for improvements from good and fair/poor baseline function, respectively. Responses to the DCE questions were analyzed using a latent-class logit model to identify systematic variations in preferences among respondents who completed each survey version.

RESULTS : 258 respondents (72 with good and 186 with fair/poor baseline function) completed the DCE. Three respondent classes were identified among respondents who completed each survey version. Patients’ age, functional score, functional treatment goals, and level of optimism about complications significantly influenced class membership. Regardless of patients’ baseline function, about 30% respondents likely preferred nonoperative management. Approximately two-thirds of patients preferred outcomes associated with UKA.

CONCLUSIONS : Preferences for treatment outcomes vary among patients with knee osteoarthritis. Understanding the various classes of patients can help physicians provide appropriate interventions and improve patient satisfaction with surgery outcomes.