African Americans and Whites Are Equally Appropriate to be Considered for Total Joint Arthroplasty

Abstract

Ethnic disparities in the use of total joint arthroplasty (TJA) may be attributed to differences in the clinical appropriateness to undergo TJA. We sought to determine if racial differences in clinical appropriateness for surgery existed among a sample of primary care clinic patients with moderately to severely symptomatic knee or hip osteoarthritis (OA). We used the cross-sectional data of 684 patients who are potential candidates for TJA. Using a validated TJA appropriateness algorithm, an appropriateness factor was derived using the following variables: age (50-70 or > 70 yrs), Charlson comorbidity (< or = 1 or > 1), Western Ontario and McMaster Universities OA Index (WOMAC) pain and physical function, and adequacy of previous medical management. We used logistic regression to estimate the association of race with the dichotomous outcome of clinical appropriateness for TJA consideration. Sample consisted of 425 (62%) whites and 260 (38%) African Americans; 532 (78%) had knee OA and 153 (22%) had hip OA. The mean age was 64 +/- 9 years and the mean body mass index was 33.6 +/- 8 kg/m(2). The mean overall WOMAC score was 56 +/- 14 (range 30-96), suggesting moderately severe OA. There were no significant racial group differences (p = 0.3) in the proportions of those deemed clinically appropriate for TJA. After controlling for potential confounders, race was not a predictor of clinical appropriateness for TJA (odds ratio 1.2, 95% confidence interval 0.8-1.8, p = 0.3). African Americans and whites were equally appropriate to be considered for TJA.