Racial differences in expectations of joint replacement surgery outcomes

Area of Science:

• Orthopedic Surgery
• Health Disparities Research
• Patient-Reported Outcomes

Background:

• Racial disparities in patient expectations for joint replacement surgery outcomes have been previously observed.
• Understanding these differences is crucial for managing patient expectations and optimizing surgical outcomes.

Purpose of the Study:

• To quantify racial differences in expectations for joint replacement surgery using a validated survey.
• To investigate whether factors such as disease severity, socioeconomic status, literacy, or trust explain these racial variations.

Main Methods:

• A cohort of 909 male patients (African American and white), aged 50-79, with hip or knee osteoarthritis (OA) were enrolled.
• The validated Joint Replacement Expectations Survey assessed patient expectations for pain relief, functional improvement, and psychological well-being.
• Demographic, clinical, psychological, and social data were collected from participants at two Veterans Affairs medical centers.

Main Results:

• African American patients reported significantly lower expectation scores than white patients for both knee OA (48.7 vs. 53.6) and hip OA (45.4 vs. 51.5).
• Multivariable analysis, adjusting for disease severity, socioeconomic factors, education, social support, literacy, and trust, reduced but did not eliminate these racial differences.
• Adjusted mean differences in expectation scores were 3.8 for knee OA and 4.2 for hip OA.

Conclusions:

• African American patients exhibit significantly lower expectations for joint replacement outcomes compared to white patients.
• The observed racial differences in expectations are not fully explained by variations in demographics, disease severity, socioeconomic factors, or trust.
• Further research is needed to understand the remaining unexplained disparities in patient expectations for joint replacement surgery.