Could Preoperative Preferences and Expectations Influence Surgical Decision Making? Rheumatoid Arthritis Patients Contemplating Metacarpophalangeal Joint Arthroplasty

Author(s): Mandl LA, Burke FD, Wilgis EFS, Lyman S, Katz JN, Chung KC

Source: Plast Reconstr Surg 121: 175-180, 2008.


The goals of this article were to ascertain rheumatoid arthritis patients’ expectations for MCP arthroplasty and to determine how preoperative preferences might influence patients’ surgical decision making to proceed with the procedure. Rheumatoid arthritis patients from 3 separate centers who were appropriate candidates for MCP arthroplasty were questioned about their expectations for MCP arthroplasty before deciding on whether to actually undergo the procedure. 

The results showed that the decision to proceed with surgery does not appear to be a result of disease severity or deformity as there was no appreciable difference between the patients that elected to proceed with the procedure and those that did not. The non-surgical group was more likely to be most bothered by hand weakness whereas the surgical group was more likely to be bothered by poor function. The non-surgical patients were more likely to value their own opinion as most important in the surgical decision-making. Both groups overestimated the risk of serious complications, but the surgical group was less likely to believe postoperative rehabilitation would be difficult.

Despite decades of performing MCP arthroplasty for rheumatoid arthritis patients, this is the first study to explore patients’ expectations and preferences. Those who decline surgery have different baseline preferences, expectations, and may use information differently in their decision making process. This report and future prospective trials will aid in the understanding of patient expectations and guide appropriate preoperative counseling of patients who would most likely benefit from surgery.