Clinical Orthopaedics and Related Research®

, Volume 471, Issue 2, pp 472–477 | Cite as

Disclosure of Financial Conflicts of Interest: An Evaluation of Orthopaedic Surgery Patients’ Understanding

  • Jay R. Lieberman
  • Michael J. Pensak
  • Michael S. Kelleher
  • Robin R. Leger
  • Gregory G. PolkowskiII
Symposium: Papers Presented at the Annual Meetings of The Hip Society



Industry and orthopaedic surgeons often partner to develop new technology, which can lead to orthopaedic surgeons having financial conflicts of interest (FCOI). It is essential these FCOI be conveyed clearly to patients. It is unclear, however, whether and to what degree patients understand the ramifications of physician FCOI.


We evaluated (1) patients’ concerns regarding their surgeon having FCOI or the presence of institutional FCOI, (2) the effect of surgeon FCOI on patients’ willingness to have surgery, and (3) patients’ understanding of FCOI.


We asked 101 patients (66% female) receiving total joint arthroplasty from the orthopaedic practices of two surgeons at an academic health center to complete a descriptive, correlational designed survey at their 6-week followup appointment. The data collected included patient demographics, knowledge of FCOI, and the influence of FCOI on patient attitudes toward surgery and their surgeon.


A minority of patients (13%) reported discussing FCOI with prior physicians and only 55% agreed or strongly agreed a surgeon should disclose FCOI. Only 15% of patients believed such conflicts would make them less likely to have their surgeon operate on them. Level of education was weakly correlated (Spearman’s rho = 0.29) with patient understanding of FCOI.


Overall, patients had a poor understanding of FCOI. Both level of education and previous discussions of FCOI predicted better understanding. This study emphasizes communication of FCOI with patients needs to be enhanced.



The authors thank Mark P. Cote DPT, MSCTR, for his contribution to this study.

Supplementary material

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  1. 1.
    American Academy of Orthopaedic Surgeons. Opinions on ethics and professionalism. Available at: Accessed April 12, 2012.
  2. 2.
    Crowninshield RD, Callaghan JJ. The orthopaedic profession and the industry partnership. Clin Orthop Relat Res. 2007;457:73–77.PubMedGoogle Scholar
  3. 3.
    Grady C, Horstmann E, Sussman JS, Hull SC. The limits of disclosure: what research subjects want to know about investigator financial interests. J Law Med Ethics. 2006;34:592–599, 481.Google Scholar
  4. 4.
    Gray SW, Hlubocky FJ, Ratain MJ, Daugherty CK. Attitudes toward research participation and investigator conflicts of interest among advanced cancer patients participating in early phase clinical trials. J Clin Oncol. 2007;25:3488–3494.PubMedCrossRefGoogle Scholar
  5. 5.
    Hampson LA, Agrawal M, Joffe S, Gross CP, Verter J, Emanuel EJ. Patients’ views on financial conflicts of interest in cancer research trials. N Engl J Med. 2006;355:2330–2337.PubMedCrossRefGoogle Scholar
  6. 6.
    Healy WL, Peterson RN. Department of Justice investigation of orthopaedic industry. J Bone Joint Surg Am. 2009;91;1791–1805.PubMedCrossRefGoogle Scholar
  7. 7.
    Khan MH, Lee JY, Rihn JA, Cassinelli EH, Lim MR, Kang JD, Donaldson WF 3rd. The surgeon as a consultant for medical device manufacturers: what do our patients think? Spine (Phila Pa 1976). 2007;32:2616–2618.Google Scholar
  8. 8.
    Kim SY, Millard RW, Nisbet P, Cox C, Caine ED. Potential research participants’ views regarding researcher and institutional financial conflicts of interest. J Med Ethics. 2004;30:73–79.PubMedCrossRefGoogle Scholar
  9. 9.
    Muslow JJ, Feeley TM, Tierney S. Beyond consent—improving understanding in surgical patients. Am J Surg. 2012;203:112–120.CrossRefGoogle Scholar
  10. 10.
    Rajaratnam A. Current trends in the relationship between orthopaedic surgeons and industry. J Bone Joint Surg Br. 2009;91:1265–1266.PubMedCrossRefGoogle Scholar
  11. 11.
    Tattersall MH, Dimoska A, Gan K. Patients expect transparency in doctors’ relationships with the pharmaceutical industry. Med J Aust. 2009;190:65–68.PubMedGoogle Scholar
  12. 12.
    Weinfurt KP, Friedman JY, Dinan MA, Allsbrook JS, Hall MA, Dhillon JK, Sugarman J. Disclosing conflicts of interest in clinical research: views of institutional review boards, conflict of interest committees, and investigators. J Law Med Ethics. 2006;34:581–591, 481.Google Scholar
  13. 13.
    Weinfurt KP, Hall MA, Dinan MA, Depuy V, Friedman JY, Allsbrook JS, Sugarman J. Effects of disclosing financial interests on attitudes toward clinical research. J Gen Intern Med. 2008;23:860–866.PubMedCrossRefGoogle Scholar
  14. 14.
    Weinfurt KP, Hall MA, King NM, Friedman JY, Schulman KA, Sugarman J. Disclosure of financial relationships to participants in clinical research. N Engl J Med. 2009;361:916–921.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Jay R. Lieberman
    • 1
  • Michael J. Pensak
    • 1
  • Michael S. Kelleher
    • 2
  • Robin R. Leger
    • 1
  • Gregory G. PolkowskiII
    • 1
  1. 1.Department of Orthopaedic Surgery, New England Musculoskeletal InstituteUniversity of Connecticut Health CenterFarmingtonUSA
  2. 2.Department of Internal MedicineHospital of Saint RaphaelNew HavenUSA

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