Reasons for refusal of total knee arthroplasty among pati̇ents recommended for surgery in turkey secondary-level publi̇c hospi̇tals: A cross-secti̇onal questi̇onai̇re-based study

INTRODUCTION: This study aims to identify the reasons why patients declined total knee arthroplasty (TKA) despite being advised to undergo the procedure in secondary-level public hospitals and to examine the relationship between these reasons and various demographic variables.
METHODS: A retrospective, cross-sectional study was conducted in 2024. The study included 50 patients who had previously been offered total knee arthroplasty (TKA) in a secondary-level public hospital but had declined the procedure and subsequently presented to a tertiary-level university hospital. Structured face-to-face surveys were administered at the tertiary hospital. The questionnaire evaluated sociodemographic characteristics, prior health experiences, and reasons for refusing surgery in the public hospital.


RESULTS: The most frequently cited reason for refusing surgery was distrust in the physician's experience (60%), followed by concerns about hospital hygiene (58%), and staff inattentiveness (16%). Female patients more frequently cited "long waiting times" as a reason (p = 0.012). Although statistical significance was not found for other reasons across education level, income, or occupation, subgroup analysis revealed that hygiene concerns and physician distrust were more prominent in low-income, low-education, and unemployed groups.


DISCUSSION AND CONCLUSION: Patient decisions to refuse THA in public hospitals are influenced not only by clinical concerns but also by perceptual and systemic factors. These findings can inform policies to improve patient-centered care in public healthcare institutions.

Keywords: Total Knee Arthroplasty, Public Hospitals, Surgery Refusal, Patient Preference