Study Suggests African Americans and Whites Equally Appropriate Candidates for Total Joint Arthroplasty
Osteoarthritis (OA) is the most prevalent form of arthritis and is among the most common chronic conditions in the US, and knee/hip OA is among the leading causes of disability. Total joint arthroplasty (TJA) is an effective treatment option for end-stage knee/hip OA. With the aging of the US population, the use of TJA is expected to increase over the next few decades, but numerous studies have documented racial differences in the use of knee or hip joint replacement in the past 10-15 years. This study sought to determine if racial differences in clinical appropriateness for surgery existed among a sample of primary care patients (425 whites and 260 African Americans) with moderate to severe symptomatic knee or hip OA. Patients were treated at one VA hospital and one county hospital between 3/03 and 9/06. Investigators determined clinical appropriateness for TJA using an algorithm that included the following variables: age, adequacy of previous medical management, severity of pain, functional limitation and surgical risk. For example, an "appropriate" candidate for TJA would be a patient who is severely symptomatic (pain and functional limitation) despite adequate medical management, and is also healthy enough to withstand the stress of surgery.
Findings show that African Americans and whites were equally appropriate candidates for TJA. There were no significant ethnic differences found between the proportion of those deemed appropriate for TJA and those deemed inappropriate (appropriate: 25.5% African Americans vs. 29.4% whites; inappropriate: 74.5% African American vs. 70.6% whites). The only variable associated with a higher likelihood of appropriateness was being unemployed. Results indicate that patients who were unemployed, a marker of low socioeconomic status, were more likely to be appropriate candidates for TJA. The authors suggest that future studies re-examine the issue of appropriateness of TJA in patients with OA who have already undergone the procedure.
Ang D, Tahir N, Hanif H, Tong Y, and Ibrahim S. African Americans and Whites are equally appropriate to be considered for total joint arthroplasty. Journal of Rheumatology September 2009;36(9):1971-1976.
Dr. Ibrahim is part of HSR&D's Center for Health Equity Research and Promotion in Pittsburgh.