Clinical Orthopaedics and Related Research®

, Volume 470, Issue 4, pp 1046–1053 | Cite as

Shared Decision-making in Orthopaedic Surgery

  • James Slover
  • Jennifer Shue
  • Karl Koenig
Symposium: Value Based Healthcare



The process of clinical decision-making and the patient-physician relationship continue to evolve. Increasing patient involvement in clinical decision-making is embodied in the concept of “shared decision-making” (SDM), in which the patient and physician share responsibility in the clinical decision-making process. Various patients’ decision aid tools have been developed to enhance this process.


We therefore (1) describe decision-making models; (2) discuss the different types of patients’ decision aids available to practice SDM; and (3) describe the practice and early impact of SDM on clinical orthopaedic surgery.


We performed a search of the literature using PubMed/MEDLINE and Cochrane Library. We identified studies related to shared decision-making and the use of patients’ decision aids in orthopaedics. The search resulted in 113 titles, of which 21 were included with seven studies on patients’ decision aid use specifically in orthopaedics.


Although limited studies suggest the use of patients’ decision aids may enhance decision-making, conclusions about the use of these aids in orthopaedic clinical practice cannot be made and further research examining the best type, timing, and content of patients’ decision aids that will lead to maximum patient involvement and knowledge gains with minimal clinical workflow interruption are needed.


In clinical practice today, patients are increasingly involved in clinical decision-making. Further research on SDM in orthopaedic surgery examining the feasibility and impact on practice, on patients’ willingness and ability to actively participate in shared decision-making, and the timing and type of patients’ decision aids appropriate for use is still needed.


Total Joint Arthroplasty Decisional Conflict Knowledge Gain Healthcare Decision Orthopaedic Practice 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank the Orthopaedic Research and Education Foundation for their support in funding this study and the Foundation for Informed Medical Decision Making for their support in providing the patients’ decision aids.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryNYU Hospital for Joint DiseasesNew YorkUSA
  2. 2.Department of OrthopaedicsDartmouth-Hitchcock Medical CenterHanoverUSA

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