, Volume 469, Issue 7, pp 1838-1845
Date: 16 Mar 2011

Ethnic and Racial Factors Influencing Well-being, Perceived Pain, and Physical Function After Primary Total Joint Arthroplasty

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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.


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.

Patients and 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.


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.


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.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

One or more of the authors have received funding from Mercy Hospital (CJL), the Mercy Foundation (CJL), and the Arthritis Surgery Research Foundation, Inc (CJL). Dr. Carlos J. Lavernia is a consultant for MAKO Surgical Corp (Ft Lauderdale, FL) and has stock in Zimmer, Inc (Warsaw, IN) and Johnson & Johnson (New Brunswick, NJ).
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the Orthopaedic Institute at Mercy Hospital.