The MARKA Study: Maximum Acceptable Risk of complication in total Knee Arthroplasty

Project Details

The MARKA study represents an innovative clinical research project that brings together a multidisciplinary team recognised for their expertise in clinical, health services and health economics research to examine “risk-benefit” preferences in patients and surgeons considering TKA as a treatment option for end-stage osteoarthritis (OA).

OA is one of the most disabling diseases in developed countries and is responsible for significant disability in over 43 million people worldwide, 27 million of whom are 60 years of age or older. TKA is the mainstay of treatment for people with end-stage knee OA. The number of TKA’s being performed each year has risen markedly over the past decade and on average has doubled in most OECD countries. In Australia, more than 46,000 people underwent TKA in 2012 at an estimated cost exceeding $1billion. While the beneficial impact of TKA on pain, disability and quality of life have been confirmed, many reports suggest 20-40% of patients express dissatisfaction post-operatively despite TKA procedures being technically and radiologically satisfactory. Patient expectation is the strongest predictor of satisfaction following TKA. Unrealistic patient expectations and uninformed perceptions of potential benefits, risks and limitations of surgery lead to dissatisfaction following TKA.

The MARKA Study will use discreet choice experiments to i) estimate the maximum acceptable risk (MAR) of complications that patients with end-stage OA consenting to undergo TKA are willing to tolerate in exchange for improvement in pain and disability and ii) compare benefit and risk preferences of patients with end-stage OA undergoing TKA with surgeon preferences. Understanding how patients and clinicians balance the benefits and risks of undergoing TKA is critical for improving patient satisfaction and reducing the burden of poor outcomes of TKA that require ongoing care that is an imposition on an already overburdened health system.



  • Prof Wendy Brown (CI-B), Centre for Obesity Research and Education, Monash University
  • Prof Danny Liew (CI-C),  Department of Epidemiology and Preventive Medicine, Monash University
  • Prof Paul Obrien (AI) Centre for Obesity Research and Education, Monash University



Research Group

Advanced Limb Reconstruction

Faculty Research Themes

Infection and Immunology

School Research Themes

Musculoskeletal , Critical Care

Key Contact

For further information about this research, please contact the research group leader.

Department / Centre


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