Fear in arthroplasty surgery: the role of race

Carlos J Lavernia, Jose C Alcerro, Mark D Rossi, Carlos J Lavernia, Jose C Alcerro, Mark D Rossi

Abstract

Understanding the difference in perceived functional outcomes between whites and blacks and the influence of anxiety and pain on functional outcomes after joint arthroplasty may help surgeons develop ways to eliminate the racial and ethnic disparities in outcome. We determined the difference in functional outcomes between whites and blacks and assessed the influence of fear and anxiety in total joint arthroplasty outcomes in 331 patients undergoing primary hip and knee arthroplasty. WOMAC, Quality of Well Being, SF-36, and Pain and Anxiety Symptoms Scale (PASS) were administered pre- and postoperatively (average 5-year followup). For the SF-36 General Health Score, blacks reported having worse perceived general health than whites before surgery. Regardless of time, blacks scored worse than whites for all measures except for the SF-36 physical function and general health scores. Blacks had a greater fear score (ie, that associated with the procedure) and total PASS score. For both races, there was a low association between the fear dimensions and dependent measures before and after surgery. Black patients undergoing hip and knee arthroplasty had lower scores than whites in most outcome measures regardless of time of assessment. We found higher fear levels before joint arthroplasty in blacks compared with whites. After surgery, blacks had much higher associations of the fear subscale, cognitive subscale, and total PASS score with the WOMAC physical function, pain, and total scores.

Level of evidence: Level II, prospective controlled cohort study. See Guidelines for Authors for a complete description of levels of evidence.

Figures

Fig. 1
Fig. 1
The graph shows the SF-36 general health score between races before and after surgery. Blacks report worse perceived general health than whites before surgery. Before = before surgery; after = after surgery; error bars = standard error of mean.
Fig. 2
Fig. 2
The graph shows the fear score between races before surgery. Blacks report more fear of pain with associated surgery than whites.
Fig. 3
Fig. 3
The graph shows the Pain and Anxiety Symptoms Scale (PASS) score between races before surgery. The overall PASS score for blacks was worse than whites before surgery.

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