312 - LONGITUDINAL PATTERNS OF TOTAL JOINT REPLACEMENT WILLINGNESS IN THE MULTICENTER OSTEOARTHRITIS STUDY

Grace Wolfe; Sarah Tilley; Gillian Hawker; James Torner; Beth Lewis; Michael C. Nevitt; Tuhina Neogi

doi:10.1016/j.joca.2026.01.318

Purpose (the aim of the study): Total joint replacement (TJR) offers substantial symptom relief for knee and hip osteoarthritis (OA) for most patients. Despite its efficacy, TJR is underutilized by patients who could benefit. Differences in willingness to undergo TJR may partially explain this gap. We examined characteristics potentially related to TJR willingness (including physician recommendation), how willingness changed over nine years, and the proportion of participants who ultimately underwent TJR. Methods: We used data from the Multicenter Osteoarthritis Study (MOST), an NIH-funded longitudinal cohort of older adults with or at risk of knee OA. At 5-, 7-, 12-, and 14-year follow-up visits, participants rated their willingness to undergo TJR for their hips or knees based on their understanding of the risks and benefits and if their symptoms were severe enough using a five-point Likert scale. Responses were categorized as willing (probably and definitely), unsure, or unwilling (probably and definitely). Participants also reported whether their physician had recommended TJR and any new TJR at each visit. Those with prior TJR at year 5 were excluded (n=497). We evaluated participant characteristics by willingness status at year 5 (baseline for these analyses) and generated an alluvial plot to examine transitions in willingness until the occurrence of the first TJR or death over the nine-year follow-up period. Results: Among the 2,166 participants included, 74.7% (n=1,617) were willing, 18.1% (n=391) were unsure, and 7.3% (n=158) were unwilling at baseline. Relative to willing and unsure participants, unwilling participants were slightly older and had higher proportions of individuals who were unmarried, non-White, and without college or graduate education. They also reported worse pain and functional impairment (higher WOMAC scores), a greater prevalence of radiographic knee OA (KL grade ≥ 2), and a greater proportion who had received a physician recommendation for TJR (Table). Participants willing at baseline tended to remain so, while unsure and unwilling participants transitioned between categories more often (Figure). During follow-up, 17.5% (n=380) underwent their first TJR, 10.1% died, and 25.5% were lost to follow-up. TJR occurred in 19% of those initially willing, 13.3% of those unsure, and 12.7% of those unwilling. Among the 238 participants who reported ever receiving a physician recommendation for TJR at baseline, 49.6% underwent the procedure within nine years; 83.9% of these recipients were initially willing, 10.2% were unsure, and 5.9% were unwilling. Conclusions: Unwilling participants had a higher proportion with a recommendation for TJR by their physician, had worse pain and function, and more radiographic OA, yet underwent the procedure the least over nine years compared to other groups. Willingness to undergo TJR did not change substantially over nine years, particularly for those initially willing. Among participants who received a recommendation and eventually underwent TJR, most were also willing at baseline. These findings highlight the need to identify and address factors that influence willingness to undergo TJR to better facilitate informed decision-making regarding TJR.

312 - LONGITUDINAL PATTERNS OF TOTAL JOINT REPLACEMENT WILLINGNESS IN THE MULTICENTER OSTEOARTHRITIS STUDY

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