Racial variations in the utilization of knee and hip joint replacement: an introduction and review of the most recent literature

Abstract

Elective knee and hip joint replacements are cost-effective treatment options in the management of end-stage knee and hip osteoarthritis. Yet there are marked racial disparities in the utilization of this treatment even though the prevalence of knee and hip osteoarthritis does not vary greatly by race or ethnicity. This article briefly reviews the rationale for understanding this disparity, the evidence-base that supports the existence of racial or ethnic disparity as well as some known potential explanations. Also, briefly summarized here are the most recent original research articles that focus on race and ethnicity and total joint replacement in the management of chronic knee or hip pain and osteoarthritis. The article concludes with a call for more research, examining patient, provider and system-level factors that underlie this disparity and the design of evidence-based, targeted interventions to eliminate or reduce any inequities.

Figure 1

Age-adjusted rates* of total knee replacement^† among Medicare enrollees,^§ by white or black race – United States, 2000–2006. Reproduced with permission: Centers for Disease Control and Prevention (CDC). Racial disparities in total knee replacement among medicare enrollees - United States, 2000–2006. MMWR Morb Mortal Wkly Rep. 2009;58(6):133–138.

Figure 2

Expectations and knowledge about joint replacement. (Reproduced with permission: Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Understanding ethnic differences in the utilization of joint replacement for osteoarthritis: the role of patient-level factors. Med Care. 2002;40(1 Suppl):I44-I51.)

Figure 3

Patient race and surgical outcome expectations regarding knee replacement. (Reproduced with permission: Groeneveld PW, Kwoh CK, Mor MK, et al. Racial differences in expectations of joint replacement surgery outcomes. Arthritis Rheum. May 15 2008;59(5):730–737.)

Figure 4

Patient race and surgical outcome expectations regarding hip replacement. (Reproduced with permission: Groeneveld PW, Kwoh CK, Mor MK, et al. Racial differences in expectations of joint replacement surgery outcomes. Arthritis Rheum. May 15 2008;59(5):730–737.)