Racial differences in expectations of joint replacement surgery outcomes

Abstract

Objective: Prior studies have indicated racial differences in patients' expectations for joint replacement surgery outcomes. The goal of this study was to measure these differences using a well-validated survey instrument and to determine if the differences could be explained by racial variation in disease severity, socioeconomic factors, literacy, or trust.

Methods: Detailed demographic, clinical, psychological, and social data were collected from 909 male patients (450 African American, 459 white) ages 50-79 years with moderate or severe osteoarthritis (OA) of the hip or knee receiving primary care at 2 veterans affairs medical centers. The previously validated Joint Replacement Expectations Survey was used to assess expectations for pain relief, functional improvement, and psychological well-being after joint replacement.

Results: Among knee OA patients (n = 627), the unadjusted mean expectation score (scale 0-76) for African American patients was 48.7 versus 53.6 for white patients (mean difference 4.9, P < 0.001). For hip OA patients (n = 282), the unadjusted mean expectation score (scale 0-72) for African Americans was 45.4 versus 51.5 for whites (mean difference 6.1, P < 0.001). Multivariable adjustment for disease severity, socioeconomic factors, education, social support, literacy, and trust reduced these racial differences to 3.8 points (95% confidence interval [95% CI] 1.2, 6.3) among knee OA patients and 4.2 points (95% CI 0.4, 8.0) among hip patients.

Conclusion: Among potential candidates for joint replacement, African American patients have significantly lower expectations for surgical outcomes than white patients. This difference is not entirely explained by racial differences in demographics, disease severity, education, income, social support, or trust.

Figures

Figure 1

Distribution of Joint Replacement Expectations Survey (JRES) scores for white patients and African American patients with knee osteoarthritis. Dot plots indicate individual responses, with the horizontal black lines indicating the mean. The corresponding box-and-whiskers plot indicates the median (horizontal line), interquartile range (box), and 2.5th to 97.5th percentiles (whiskers). The y-axis indicates the total JRES score.

Figure 2

Distribution of Joint Replacement Expectations Survey (JRES) scores for white patients and African American patients with hip osteoarthritis. Dot plots indicate individual responses, with the horizontal black lines indicating the mean. The corresponding box-and-whiskers plot indicates the median (horizontal line), interquartile range (box), and 2.5th to 97.5th percentiles (whiskers). The y-axis indicates the total JRES score.