Mehmet Can GEZER, Seyyid Şerif ÜNSAL
Eastern Journal of Medicine (EJM) - 2026;31(2):319-325
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. A descriptive, cross-sectional study was conducted in 2025. 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. 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. Patient decisions to refuse TKA 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.
