Journal of General Internal Medicine

, Volume 25, Issue 9, pp 982–988 | Cite as

The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting

  • Leslie R. M. Hausmann
  • Maria Mor
  • Barbara H. Hanusa
  • Susan Zickmund
  • Peter Z. Cohen
  • Richard Grant
  • Denise M. Kresevic
  • Howard S. Gordon
  • Bruce S. Ling
  • C. Kent Kwoh
  • Said A. Ibrahim
Original Research



The extent to which treatment recommendations in the orthopedic setting contribute to well-established racial disparities in the utilization of total joint replacement (TJR) in the treatment of advanced knee/hip osteoarthritis has not been explored.


To examine whether orthopedic surgeons are less likely to recommend TJR to African-American patients compared to white patients with similar clinical indications, and whether there are racial differences in the receipt of TJR within six months of study enrollment.


Prospective, observational study.


African-American (AA; n = 120) and white (n = 337) patients seeking treatment for knee or hip osteoarthritis in Veterans Affairs orthopedic clinics.


Patients completed surveys that assessed socio-demographic and clinical variables that could influence osteoarthritis treatment. Orthopedic surgeons’ notes were reviewed to determine whether patients had been recommended for TJR and whether they underwent the procedure within 6 months of study enrollment.


Rate of TJR recommendation was 19.5%. Odds of receiving a TJR recommendation were lower for AA than white patients of similar age and disease severity (OR = 0.46, 95% CI = 0.26–0.83; P = 0.01). However, this difference was not significant after adjusting for patient preference for TJR (OR = 0.69, 95% CI = 0.36–1.31, P = 0.25). Overall, 10.3% of patients underwent TJR within 6 months. TJR was less likely for AA patients than for white patients of similar age and disease severity (OR = 0.41, 95% CI = 0.16–1.05, P = 0.06), but this difference was reduced after adjusting for whether patients had received a recommendation for the procedure at the index visit (OR = 0.57, 95% CI = 0.21–1.54, P = 0.27).


In this study, race differences in patient preferences for TJR appeared to underlie race differences in TJR recommendations, which led to race differences in utilization of the procedure. Our findings suggest that patient treatment preferences play an important role in racial disparities in TJR utilization in the orthopedic setting.


healthcare disparities total joint replacement orthopedic surgery osteoarthritis patient preference 


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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Leslie R. M. Hausmann
    • 1
  • Maria Mor
    • 1
    • 2
  • Barbara H. Hanusa
    • 1
    • 3
  • Susan Zickmund
    • 1
    • 4
  • Peter Z. Cohen
    • 4
  • Richard Grant
    • 5
    • 6
  • Denise M. Kresevic
    • 5
    • 6
  • Howard S. Gordon
    • 7
    • 8
  • Bruce S. Ling
    • 1
    • 4
  • C. Kent Kwoh
    • 1
    • 4
  • Said A. Ibrahim
    • 9
    • 10
  1. 1.Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghUSA
  2. 2.Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  3. 3.Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghUSA
  4. 4.School of MedicineUniversity of PittsburghPittsburghUSA
  5. 5.Louis Stokes DVA Medical CenterClevelandUSA
  6. 6.University Hospitals Case Medical CenterClevelandUSA
  7. 7.Jesse Brown VA Medical Center, Center for Complex Chronic CareChicagoUSA
  8. 8.College of MedicineUniversity of Illinois at ChicagoChicagoUSA
  9. 9.Center for Health Equity Research and PromotionPhiladelphia VA Medical CenterPhiladelphiaUSA
  10. 10.School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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