title: Who, when, and why total joint replacement surgery? The patient's perspective.
abstract: OBJECTIVE
  Although total joint replacement is an effective treatment for advanced arthritis, many whom might benefit are unwilling to consider this procedure. This review highlights advances in understanding of patients' perceptions of total joint replacement.
  
  
  RESULTS
  Research shows that patients' willingness to consider total joint replacement varies by sex, race/ethnicity, and socioeconomic status as a result of systematic differences in knowledge and beliefs about the procedure. Individuals with low socioeconomic status and minorities view the procedure less favorably than their wealthier, white counterparts, possibly partly explaining disparity in rates of use of the procedure among these groups. Among those undergoing total joint replacement, up to 30% experience a suboptimal outcome or are dissatisfied with results. Early work suggests that patients' expectations and self-efficacy are important potential predictors of postoperative outcome. Patient information needs regarding total joint replacement vary significantly and possibly systematically by sex and race/ethnicity. Available information materials may not address the concerns of many individuals contemplating the procedure, posing a potential barrier to surgery.
  
  
  CONCLUSIONS
  Targeted culturally sensitive knowledge dissemination strategies are needed to improve the knowledge and beliefs of people with hip/knee arthritis about total joint replacement.
authors.affiliation: Division of Rheumatology, Department of Medicine, Women's College Hospital, University of Toronto, 76 Grenville Street, Toronto, Ontario, Canada. g.hawker@utoronto.ca
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Hawker
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000208:ethnology* / Q000523:psychology* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000208:ethnology* / Q000523:psychology* / Q000601:surgery; D010353:Patient Education as Topic; D012737:Sex Factors; D012959:Socioeconomic Factors