The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting.
BACKGROUND
The extent to which treatment recommendations in the orthopedic setting contribute to well-established racial disparities in the utilization of total joint replacement (TJR) in the treatment of advanced knee/hip osteoarthritis has not been explored.


OBJECTIVE
To examine whether orthopedic surgeons are less likely to recommend TJR to African-American patients compared to white patients with similar clinical indications, and whether there are racial differences in the receipt of TJR within six months of study enrollment.


METHODS
Prospective, observational study.


METHODS
African-American (AA; n = 120) and white (n = 337) patients seeking treatment for knee or hip osteoarthritis in Veterans Affairs orthopedic clinics.


METHODS
Patients completed surveys that assessed socio-demographic and clinical variables that could influence osteoarthritis treatment. Orthopedic surgeons' notes were reviewed to determine whether patients had been recommended for TJR and whether they underwent the procedure within 6 months of study enrollment.


RESULTS
Rate of TJR recommendation was 19.5%. Odds of receiving a TJR recommendation were lower for AA than white patients of similar age and disease severity (OR = 0.46, 95% CI = 0.26-0.83; P = 0.01). However, this difference was not significant after adjusting for patient preference for TJR (OR = 0.69, 95% CI = 0.36-1.31, P = 0.25). Overall, 10.3% of patients underwent TJR within 6 months. TJR was less likely for AA patients than for white patients of similar age and disease severity (OR = 0.41, 95% CI = 0.16-1.05, P = 0.06), but this difference was reduced after adjusting for whether patients had received a recommendation for the procedure at the index visit (OR = 0.57, 95% CI = 0.21-1.54, P = 0.27).


CONCLUSIONS
In this study, race differences in patient preferences for TJR appeared to underlie race differences in TJR recommendations, which led to race differences in utilization of the procedure. Our findings suggest that patient treatment preferences play an important role in racial disparities in TJR utilization in the orthopedic setting.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive (151C-H), Pittsburgh, PA 15206, USA. leslie.hausmann@gmail.com
Leslie R M
LR
Hausmann
Maria
M
Mor
Barbara H
BH
Hanusa
Susan
S
Zickmund
Peter Z
PZ
Cohen
Richard
R
Grant
Denise M
DM
Kresevic
Howard S
HS
Gordon
Bruce S
BS
Ling
C Kent
CK
Kwoh
Said A
SA
Ibrahim
D001741:Black or African American; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015207:Osteoarthritis, Hip / Q000208:ethnology* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000208:ethnology* / Q000601:surgery; D010044:Outpatient Clinics, Hospital; D057240:Patient Preference / Q000208:ethnology; D011446:Prospective Studies; D044465:White People