Process evaluation of a second opinion intervention

Effectiveness of a second opinion concept before knee endoprosthesis surgery

Funded by: AOK Bayern

Period: 2019 –2023

Germany is among the leading countries in the number of knee TEPs worldwide. However, regardless of the prevalence of the underlying disease, the frequency of implantation is subject to a strong regional variation. Bavaria has the highest rate, which is twice as high as in Berlin.
These differences cannot be adequately explained by differences in morbidity, but can indicate deficiencies in the decision-making process before implantation. As a consequence of possibly inadequate decision-making processes and the associated potential incorrect care, avoidable health costs, health risks and patient dissatisfaction can arise.
Obtaining a second opinion from an independent, experienced specialist can avoid unnecessary surgery and support the patient in decision-making. Approximately half of the available health insurances in Germany offer second opinion programs, most of these are for orthopedics. However, there is little evidence on the effects of second opinion procedures. Thus, it remains unclear whether obtaining a second opinion supports patients in the decision-making process.
In cooperation with the Department for Orthopedic Surgery, Physical Medicine and Rehabilitation at the Hospital of the Ludwig-Maximilians-University, AOK-Bayern offers a second opinion for patients with recommendations for knee TEP. This study accompanies the project scientifically.

Project Aims

The aim of the project is to investigate the effects of a second opinion on the implantation of knee endoprostheses in patients with osteoarthritis. Alongside the study, a process evaluation will be conducted. The process evaluations aims to identify factors that lead to deviations in the implementation of the program. The results of the process evaluation can contribute to the modification and optimization of the program.

Specific goals are:

  • Examine the acceptance and feasibility of the program among executing physicians and patients
  • Compare quality of life, pain and functionality after three and 12 months between patients in the second opinion program and patients without a program
  • Compare the frequency of the intervention and the type and amount of therapy after three and 12 months between patients in the second opinion program and patients without a progr


Contact: Dr. Rebecca Kisch