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Arthritis Research and Therapy

, 17:348

First Online: 03 December 2015Received: 27 May 2015Accepted: 17 November 2015


IntroductionPatient preferences contribute to marked racial disparities in the utilization of total knee replacement TKR. The objectives of this study were to identify the determinants of knee osteoarthritis OA patients’ preferences regarding TKR by race and to identify the variables that may mediate racial differences in willingness to undergo TKR.

MethodsFive hundred fourteen White WH and 285 African-American AA patients with chronic knee pain and radiographic evidence of OA participated in the study. Participants were recruited from the community, an academic medical center, and a Veterans Affairs hospital. Structured interviews were conducted to collect socio-demographics, disease severity, socio-cultural determinants, and treatment preferences. Logistic regression was performed, stratified by race, to identify determinants of preferences. Clinical and socio-cultural factors were entered simultaneously into the models. Stepwise selection identified factors for inclusion in the final models p < 0.20.

ResultsCompared to WHs, AAs were less willing to undergo TKR 80 % vs. 62 %, respectively. Better expectations regarding TKR surgery outcomes determined willingness to undergo surgery in both AAs odds ratio OR 2.08, 95 % confidence interval CI 0.91-4.79 for 4 vs. 1 quartile and WHs OR 5.11, 95 % CI 2.31-11.30 for 4 vs. 1 quartile. Among AAs, better understanding of the procedure OR 1.80, 95 % CI 0.97-3.35, perceiving a short hospital course OR 0.81, 95 % CI 0.58-1.13, and believing in less post-surgical pain OR 0.73, 95 % CI 0.39-1.35 and walking difficulties OR 0.66, 95 % CI 0.37-1.16 also determined willingness. Among WHs, having surgical discussion with a physician OR 1.96, 95 % CI 1.05-3.68, not ever receiving surgical referral OR 0.56, 95 % CI 0.32-0.99, and higher trust in the healthcare system OR 1.58, 95 % CI 0.75-3.31 for 4 vs. 1 quartile additionally determined willingness. Among the variables considered, only knowledge-related matters pertaining to TKR attenuated the racial difference in knee OA patients’ treatment preference.

ConclusionsExpectations of surgical outcomes influence preference for TKR in all patients, but clinical and socio-cultural factors exist that shape marked racial differences in preferences for TKR. Interventions to reduce or eliminate racial disparities in the utilization of TKR should consider and target these factors.

KeywordsOsteoarthritis Knee replacement surgery Race Health disparity Treatment preference AbbreviationsAAAfrican-American

CIconfidence interval

HSSHospital for Special Surgery

MOS-SSSMedical Outcomes Study-social support scale


ORodds ratio

PHQ-9Patient Health Questionnaire-9

SF12Short Form Health Survey

TKRtotal knee replacement

VAVeterans Affairs


WOMACWestern Ontario McMaster Index

Electronic supplementary materialThe online version of this article doi:10.1186-s13075-015-0864-2 contains supplementary material, which is available to authorized users.

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Autor: C. Kent Kwoh - Ernest R. Vina - Yona K. Cloonan - Michael J. Hannon - Robert M. Boudreau - Said A. Ibrahim


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