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Health Services Research & Development

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2006 HSR&D National Meeting Abstract

3030 — Racial Differences in Expectations of Joint Replacement Outcomes among Veterans with Osteoarthritis

Author List:
Groeneveld PW (Philadelphia VAMC / CHERP)
Kwoh CK (Pittsburgh VAHCS / CHERP)
Appelt CJ (Pittsburgh VAHCS / CHERP)
Gutierrez J (Philadelphia VAMC / CHERP)
Resnick AL (Pittsburgh VAHCS / CHERP)
Ibrahim SA (Pittsburgh VAHCS / CHERP)

The rates at which black and white veterans with osteoarthritis undergo joint replacement surgery are substantially different. Expectations of the outcomes of surgery, such as improvement in functional status, pain, and quality of life, are likely to influence the willingness of patients to undergo surgery. There are limited data on whether blacks and whites differ in their beliefs about the likely benefits of elective joint replacement.

We surveyed veterans ages 50-79 receiving primary care in the Pittsburgh VA Health Care System or Philadelphia VA Medical Center. Patients were eligible to enroll in the study if they indicated moderate or severe hip or knee pain, stiffness, and functional difficulty as indicated by the Western Ontario and McMaster Universities Osteoarthritis Index. We used the previously-validated Hospital for Special Surgery Joint Replacement Expectations Survey (HSS-JRES) to assess patients’ expectations for pain relief, functional improvement, and psychological well-being after surgery. Possible scores on the HSS-JRES range from 0-76 for knee replacement and 0-72 for hip replacement, with higher scores indicating more optimistic expectations for surgical outcomes. The survey was administered to 210 (117 black, 93 white) veterans with knee osteoarthritis and 105 (50 black, 55 white) veterans with hip osteoarthritis.

Among patients with knee osteoarthritis, the average HSS-JRES score for whites was 49.5 (95% confidence interval [CI] 46.2–52.9) and blacks averaged 42.7 (95% CI 39.6–45.7, p<0.0001 for the difference). Among patients with osteoarthritis of the hip, white veterans had a mean response of 46.7 (95% CI 43.4–50.0) compared to a mean response of 39.5 (95% CI 35.6–43.5, p<0.0001 for the difference) among black veterans. 24% of black patients compared to 11% of white patients scored below 30 on the knee expectations scale. 22% of blacks compared to 7% of whites scored below 30 on the hip expectations scale.

Among veterans with moderate-to-severe knee or hip osteoarthritis, whites have substantially higher expectations for the physical, functional, and psychological benefits of joint replacement surgery.

The difference in therapeutic expectations between whites and blacks may be an important and potentially remediable cause of the racial disparity in joint replacement rates.

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