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December 27, 2024, Paper: "Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are highly effective procedures for end-stage disease of the hip and knee joints respectively [1]. However, like all elective orthopaedic surgical procedures, they carry a risk of major and minor complications [[2], [3], [4]] and long-term dissatisfaction [5].Shared decision-making and informed consent are crucial in orthopaedic surgical care to respect patient autonomy, improve the subjective patient experience, and ensure patients make the most appropriate decision for their unique situation [6,7]. This is especially important in elective orthopaedic care such as hip and knee arthroplasty which are preference sensitive, meaning the ‘right treatment depends on a given patient’s preferences and the relative weight the patient gives to the risk and benefit of treatment’ [8]. The framing effect, a well-established cognitive bias where systematically different choices are made depending on whether options are expressed in terms of gains or losses, has never been described in the setting of elective orthopaedic surgery [9]. This study sought to investigate the impact of positive or negative framing of perioperative complication risk on patient decision-making in the elective THA context, as well as the impact of positive or negative framing of long-term satisfaction rates on patient decision-making in the elective TKA context, using simulated vignette scenarios, an established method [10]. Outcomes of interest were the decision to proceed with surgery and ‘worry’ about complication risk and long-term outcomes."