title: Ethnic and racial factors influencing well-being, perceived pain, and physical function after primary total joint arthroplasty.
abstract: BACKGROUND
  Studies suggest, even when controlling for disease severity, socioeconomic status, education, and access to care, racial and ethnic minorities receive lower-quality health care and have worse perceived pain and function before and after total joint arthroplasty.
  
  
  OBJECTIVE
  We evaluated the influence of race and ethnicity on well-being, pain, and function after total joint arthroplasty and determined whether race, ethnicity, sex, and joint involvement influenced perceived function and pain after total joint arthroplasty.
  
  
  METHODS
  We retrospectively reviewed the records of 1749 patients receiving total joint arthroplasty (739 hips and 1010 knees). Sixty-eight percent were women, with a mean age of 65 years at followup. We assessed patients preoperatively and at a minimum of 2 years (mean, 5.1 years; range, 2-16 years) on perceived well-being, function, and pain, as well as clinical assessment tools. Also, we assessed the behavior of dependent measures between groups over time.
  
  
  RESULTS
  Preoperatively, in both TKA and THA candidates, African American patients presented with worse scores. Postoperatively, all patients had substantial improvement, yet African Americans who had TKA or THA continued to have worse scores on some measures. In both TKA and THA, women had worse scores.
  
  
  CONCLUSIONS
  Racial and ethnic minorities undergoing hip and knee arthroplasty appear to have worse patient-perceived outcomes (well-being, pain, and function) when compared to whites. This discrepancy is most pronounced for African Americans.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Orthopaedic Institute at Mercy Hospital, 3659 S Miami Avenue, Suite 4008, Miami, FL 33133, USA. CLavernia@mercymiami.org
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Lavernia
authors.forename: Jose C
authors.initials: JC
authors.lastname: Alcerro
authors.forename: Juan S
authors.initials: JS
authors.lastname: Contreras
authors.forename: Mark D
authors.initials: MD
authors.lastname: Rossi
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005006:Ethnicity; D005260:Female; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D054525:Minority Health / Q000208:ethnology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000208:ethnology* / Q000503:physiopathology; D017060:Patient Satisfaction / Q000208:ethnology*; D011787:Quality of Health Care; D020127:Recovery of Function; D012189:Retrospective Studies