Shared Decision Making in Joint Surgery: How to Be an Active Partner in Your Surgery Decision

Key Takeaways

• Shared decision making pairs your surgeon’s clinical knowledge with what only you know about your goals, work and daily life.
• Australian codes of conduct support your right to ask questions, take time, seek a second opinion and know the costs before you consent.
• Three questions cover most of the ground. What are my options, what are the benefits and harms, and how likely are they for me.
• Non-surgical care stays on the table throughout, and consent can be withdrawn at any point before your operation.

Somewhere between the scan appearing on the screen and the words ‘joint replacement’, most people stop absorbing detail. The questions arrive later, in the car park or at 2 am. Shared decision making in joint surgery exists to close that gap, and it gives you a structured way to bring your own knowledge into the room alongside your surgeon’s.

The model is not about second-guessing a specialist. It recognises that a hip or knee decision rests on two sets of information. One is clinical, covering imaging, anatomy, technique and what tends to happen across large numbers of patients. The other is personal, covering what the joint is costing you, what you want back and what you are prepared to trade to get it. A recommendation built on only half of that is incomplete.

Most people meet this idea for the first time in a specialist consultation, which is often the least familiar 20 minutes of the process. Knowing what you are entitled to ask and what a thorough answer sounds like turns the appointment into a working conversation. It applies whether you are seeing orthopaedic surgeons in Sydney for a first opinion or returning to review a plan you have been sitting with for months.

What Shared Decision Making Means in Joint Surgery

The phrase can sound like a formality, something ticked off in the final minutes of a consultation. In practice it describes a specific way of working through a choice where more than one reasonable path exists:

Two Kinds of Knowledge in the Room

Your surgeon knows the anatomy, the imaging, the technique and the patterns that emerge across many patients. You know how the joint behaves at 6 am, which activities you have quietly stopped doing, how much leave you can take, who is at home to help and what you are hoping to get back.

The Agency for Clinical Innovation (ACI) in New South Wales (NSW) describes shared decision making as patients, families, carers and health professionals working together to decide on care based on the patient’s goals, preferences and the available evidence on treatment options. Neither side holds the whole picture alone.

Consent Versus Shared Decision Making

The Medical Board of Australia defines informed consent as a person’s voluntary decision about medical care, made with knowledge and understanding of the benefits and risks involved. That is the formal agreement, and it happens at a single point.

Shared decision making is the conversation that makes the agreement meaningful. It may run across several appointments, involve your general practitioner (GP) and your physiotherapist, and include periods where you go away and think.

Preference-Sensitive Decisions

Many joint decisions are preference-sensitive, which means the evidence does not point to a single superior path and the trade-offs land differently depending on the person. A keen tennis player in their 50s and a retiree who mainly wants to walk the dog comfortably may reasonably reach different conclusions from similar-looking scans.

A surgeon who presents options instead of issuing an instruction is reflecting that reality, not hedging.

Situations Where Time Is Limited

Not every orthopaedic decision allows a long deliberation. An acute fracture, a dislocation or a serious infection may need action within hours, and the conversation compresses accordingly. Elective joint surgery for osteoarthritis sits at the other end of that spectrum, where time to consider is usually available and worth using.

Your Rights as a Patient in the Australian Health System

Being an active partner becomes easier once you know what the system already expects of your treating team. Several Australian frameworks set this out clearly:

Partnership and Information Under the Charter

The Australian Charter of Healthcare Rights sets out seven rights that apply anywhere you receive care in Australia, including access, safety, respect, partnership, information, privacy and the right to give feedback.

Partnership covers asking questions, taking part in open and honest discussion, and making decisions with your provider. Information covers being told about the possible benefits and risks of different tests and treatments so you can decide what suits you. Both are stated entitlements, not favours.

Support for a Second Opinion

Good medical practice, the Medical Board of Australia’s code of conduct for doctors, lists supporting a patient’s right to seek a second opinion among the elements of good care. Requesting one is a normal part of a significant elective decision and is not a judgement on the surgeon in front of you.

Transparency About Fees and Costs

The same code asks doctors to inform patients about fees and charges in a timely way, so patients can decide whether to proceed, and to advise that a referral for further investigation or treatment may carry additional costs.

For joint surgery, several separate accounts may be involved:

• Surgeon’s fee for the procedure
• Anaesthetist’s fee, billed separately
• Surgical assistant’s fee, where one is used
• Hospital and theatre charges, including the implant
• Health fund excess, plus any out-of-pocket gap
• Rehabilitation and equipment needed at home

This list is a general guide only. The accounts that apply, and the amounts involved, vary by procedure, hospital, health fund and individual circumstances.

Time to Consider Before Consenting

Across the National Scheme regulated by the Australian Health Practitioner Regulation Agency, practitioners are expected to give patients adequate opportunity to ask questions, to question or refuse an intervention, and to make informed decisions before consent is sought.

ACI guidance adds that consent should follow after a patient has received accurate information about the procedure and the other options, has enough knowledge to weigh the benefits and risks, has considered what happens if complications occur, and has discussed their goals and wishes.

Preparing for Your Orthopaedic Appointment

Most of the value in a specialist consultation is created before you walk in:

Clarifying What Matters Most to You

Options cannot be compared without a benchmark. Write down three or four specific things the joint currently stops you from doing that you want back. ‘Walking 5 km without stopping’ or ‘getting through a shift without painkillers’ gives a surgeon something to work with. ‘Less pain’ does not.

Tracking Your Symptoms and Function

Two weeks of brief daily notes will tell a clearer story than memory. Useful things to record include night pain and sleep disruption, distance walked before pain begins, difficulty with stairs, medication use, swelling and days affected at work.

Patterns carry more weight than a single bad week, and they help distinguish a joint that is gradually declining from one that fluctuates.

Gathering Your Records and Imaging

Bring the actual images and the radiology reports, not just a recollection of what a scan showed, since x-rays and magnetic resonance imaging answer different questions. Also useful are a current medication list, other health conditions, any previous surgery or injury to the joint, and your GP referral. Missing imaging often means a repeat scan and another appointment before anything can progress.

Writing Down Your Questions

Written questions serve you better than memory under pressure. Three or four written down, ordered by what matters most, will get you further than a dozen you are trying to recall.

Put the question you are most nervous about at the top. Those are the ones that get skipped when time runs short.

Bringing a Second Set of Ears

The Australian Commission on Safety and Quality in Health Care (ACSQHC) suggests taking someone with you to appointments. A second listener catches what you miss and remembers what you were too preoccupied to register.

It is also reasonable to ask the clinician to pause, repeat something or explain a term in different words. Health professionals use language most people have never encountered, and saying so is part of the process.

Questions Worth Asking About Joint Surgery

A good question does more than retrieve a fact. It prompts a fuller explanation and surfaces the reasoning behind a recommendation:

Questions About Your Options

The Ask Share Know questions, developed in Australia and promoted by the ACSQHC, begin here. Asking ‘what are my options?’ prompts a clinician to list all of them, and for an elective decision that list usually includes waiting and monitoring.

For a painful hip or knee, that list might include structured exercise and load management, weight management, a medication review, injection therapy, joint-preserving surgery such as an osteotomy, partial replacement or total replacement. Ask why the recommended option was chosen over the others.

Questions About Benefits and Harms

The second and third Ask Share Know questions follow naturally. What are the possible benefits and harms of each option, and how likely is each of those to happen to me?

General complication rates describe a population, not a person with your age, weight, activity level, bone quality and other health conditions. Ask how those factors shift the numbers in your case.

Questions About the Procedure Itself

Useful specifics include which procedure is proposed and why, what is being removed, repaired or replaced, which surgical approach is planned, how long the operation takes, which hospital it will be performed at and what type of anaesthetic is involved.

Ask what happens if something unexpected is found once surgery is underway, and what decisions the surgeon may need to make on your behalf at that point.

Questions About Recovery and Rehabilitation

Recovery is where a decision either fits your life or does not. Ask about expected time in hospital, use of crutches or a frame, when driving resumes, when a return to your specific type of work becomes realistic and what the rehabilitation program involves week by week.

Ask who delivers that rehabilitation, how often you will be seen and what the plan is if progress stalls. A procedure and its rehabilitation are one package, not two separate decisions.

Questions About Timing

Timing is often the real question hiding behind ‘should I have surgery?’ Ask what is likely to change in the joint over the next six or twelve months, whether waiting makes the operation technically harder or the recovery slower, and what would prompt the surgeon to recommend waiting.

Questions About Experience and Outcomes

It is reasonable to ask how often a surgeon performs the procedure you are considering, what their usual results look like, and what happens if a complication occurs after you go home. Those same markers matter when choosing an orthopaedic surgeon in the first place.

Ask who to contact out of hours, and who takes over your care if your surgeon is unavailable during your recovery.

Weighing the Answers Against Your Own Life

Information alone does not produce a decision. The work sits in translating what you have been told into what it means for the way you live:

Understanding What Waiting Involves

Waiting is a decision with consequences of its own, in both directions. It may mean more months of pain, poorer sleep and further withdrawal from activity. It may also mean time to build strength, manage weight, resolve another health issue or reach a stretch of the year when a long recovery is workable.

Waiting only counts as a choice when it is made deliberately, not by default.

Comparing Non-Surgical Care With Surgery

For hip and knee osteoarthritis, structured exercise, targeted strength work and load management are usually first-line care, and for some people they may reduce pain and improve function meaningfully. Programs of this kind are typically delivered through a dedicated osteoarthritis clinic or a physiotherapy service.

This approach does not reverse structural joint damage, and it may not delay surgery for everyone. What it does do is clarify how much of your limitation comes from the joint itself and how much comes from lost strength and conditioning around it.

Making Sense of Risk Numbers

Numbers are simpler to weigh when they are expressed as natural frequencies. ‘Around 1 in 100 people’ tends to be clearer than a percentage quoted on its own, and it is fair to ask for figures in that form.

Ask where a number comes from, whether it reflects national registry data, published research or the surgeon’s own practice. Longevity figures deserve the same scrutiny, since implant survival data records whether a revision occurred, not how the joint felt.

Using a Patient Decision Aid

Patient decision aids are resources that lay out the options side by side, present the known benefits and harms, and help you work out what matters most to you. Their value is in making the trade-offs concrete rather than abstract, which helps when two options look similar on paper.

Ask whether one exists for the decision you are facing.

Naming Your Own Trade-Offs

Once the information is in, the decision turns on what you are willing to trade. Six weeks without driving might be a minor inconvenience for one person and unworkable for another.

Say these constraints out loud in the consultation. A surgeon cannot factor in a limitation they have not been told about, and the plan may be adjustable once they know.

Common Barriers to Speaking Up

Knowing you are entitled to participate and feeling able to do so are two different things. A few obstacles come up repeatedly:

Worry About Seeming Difficult

Questions are part of the process, not an obstruction to it. Good medical practice asks doctors to encourage patients to be well informed, to respond to their questions and to confirm the patient has understood what was said.

A clinician who welcomes your questions is behaving exactly as the code describes.

Gaps in Language and Health Literacy

NSW Health provides free healthcare interpreters, and ACI guidance states that an interpreter is essential where a patient does not speak or read English. Written information can also be requested in other languages or in formats combining pictures and words.

Requesting an interpreter is a right and a safety measure. Consent given through a family member translating on the fly is not consent given on solid ground.

Pressure to Decide in the Room

A decision made under time pressure is rarely improved by the speed. Taking the information home, sleeping on it and returning with follow-up questions is a legitimate use of the process.

Where you feel pushed towards a particular answer, saying ‘I would like to think about this and come back’ is enough. No further justification is required.

Keeping the Decision Open Until Surgery

Agreeing to a procedure does not close the conversation. Several things remain within your control right up to the day:

The Right to Change Your Mind

ACI perioperative guidance is direct on this point. The decision to have surgery belongs to the patient, and consent can be given or withdrawn at any time. Having a date in the diary is not a commitment you are locked into.

New information, a change in your circumstances or a shift in how the joint is behaving are all legitimate reasons to revisit the plan.

The Window Before Your Operation

The gap between deciding and operating is usable time. Organising the home for reduced mobility, arranging help for the first fortnight and confirming leave with your employer all sit in this window.

Going into surgery better organised tends to make the early weeks more manageable, though individual recovery still varies.

The Path If You Choose Not to Operate

Declining surgery is a legitimate outcome of shared decision making, not a failure of it. ACI guidance states that patients who decide against a procedure should be offered alternative clinical options, including specialist and allied health referrals aimed at improving functional status, and that the decision is communicated back to the referring practitioner along with a plan for managing any decline.

Deciding not to proceed now is not deciding never. Circumstances change, joints change and the conversation can be reopened.

A Joint Surgery Decision You Can Live With

The worry underneath most of this is rarely about the joint. It is the quiet fear of getting it wrong, or of being the patient who asks too much of someone who trained for a decade. Australian healthcare guidance expects you to participate, and it places obligations on your treating team to make that possible.

There is no single correct answer waiting to be uncovered. There is a decision that fits your goals, your body and your circumstances, and a version of that decision you can live with whichever way recovery unfolds.

You do not need medical training to do this well. You need your priorities written down, the willingness to say when something is not clear, and the knowledge that asking is exactly what the system anticipates you will do.

Considering surgery for a hip or knee? The team at MTP Health can help you weigh your options and prepare for that conversation, and your GP can advise whether a specialist referral is the right next step.

Frequently Asked Questions (FAQs)

1. What is shared decision making in joint surgery?

It is a process where you and your treating team decide on care together, drawing on the clinical evidence about your options and on your own goals and preferences.

For a hip or knee decision, that usually means comparing continued non-surgical care against one or more surgical options, and working out which set of trade-offs suits your life. It runs alongside consent, not in place of it.

2. Can I ask my orthopaedic surgeon for a second opinion?

Yes. That right is written into the Medical Board of Australia’s code of conduct for doctors, so asking is expected, not awkward.

Bring your imaging and reports with you, and arrive with a specific question so the second opinion addresses what is actually troubling you.

3. How long should I take to decide about joint replacement?

There is no fixed period, and elective surgery usually allows more time than people assume. Many patients take several weeks and return for a second consultation before committing.

Ask your surgeon what is likely to change in the joint while you consider, so the length of your deliberation is a deliberate choice.

4. What questions should I ask before agreeing to joint surgery?

Start with the three Ask Share Know questions, which cover your options, the possible benefits and harms of each, and how likely those outcomes are for you.

From there, ask about the specific procedure, the recovery timeline as it applies to your work and responsibilities, the full cost across every provider and what happens if a complication occurs.

5. Can I change my mind after consenting to surgery?

Yes. Consent belongs to you and can be withdrawn at any point before the operation, including after a date is booked.

Let the practice know as early as you reasonably can, so the theatre time can be reallocated and your ongoing care can be adjusted.

6. Does choosing non-surgical care mean I have refused treatment?

No. Non-surgical management is a treatment option, not the absence of one, and it may be the more appropriate choice at a particular stage.

Your treating team should still map out what comes next, so the pathway continues either way.

7. Who can help me prepare for the conversation?

Your GP can help you frame the question and interpret the answers afterwards. A physiotherapist or exercise physiologist can explain what rehabilitation demands and how prepared your body currently is for it.

At MTP Health, physiotherapy, exercise physiology and orthopaedic consulting sit under one roof, which can make it simpler to work through both sides of the decision.

8. Will I be told the full cost before surgery?

Not automatically, but you are entitled to ask, and the information should reach you in time to affect your decision.

Request written estimates covering the surgeon, anaesthetist, any assistant and the hospital, then confirm your excess and any exclusions directly with your health fund.

This article provides general information only. It does not take into account your medical history, your symptoms, your circumstances or your goals, and it is not a substitute for personalised advice. Any timeframes, costs or processes mentioned are a general guide and will vary from person to person. Speak with your GP, an orthopaedic surgeon or another qualified health practitioner about your own situation before making decisions about surgery or changing your treatment.