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Racial/ethnic disparities in knee replacement rates may be partly due to differences in preferences for surgery

At least part of the disparity in total knee replacement (TKR) rates among various racial and ethnic groups may be due to differences in treatment preference, suggests a recent survey. The survey used hypothetical scenarios to ask 193 adults from the general public and 198 patients with knee osteoarthritis about preferences for medical or surgical treatment of knee osteoarthritis. Of all those surveyed, blacks were 37 percent less likely to choose surgery than whites. Women and older individuals were also less likely to choose surgery.

For all racial groups, larger reductions in negative surgery symptoms significantly increased the likelihood of choosing surgery. Also, the cost of surgery highly influenced the decision regardless of income. However, the attributes of TKR that were most influential in the decision about surgery were somewhat different among black and whites, with blacks putting substantially more weight on improvements in walking ability.

More whites than blacks knew someone who had undergone TKR (72 vs. 54 percent). Thus, blacks may be less willing to choose surgery because they are they less familiar with the surgery than whites and have not seen the large improvements in function that are possible following TKR.

These findings could provide clinicians with helpful information they can use when they initiate discussions with patients considering TKR. The study was supported in part by the Agency for Healthcare Research and Quality (HS10876).

See "Racial/ethnic differences in preferences for total knee replacement surgery," by Margaret M. Byrne, Ph.D., Julianne Souchek, Ph.D., Marsha Richardson, M.S.W., and Maria Suarez-Almazor, M.D., Ph.D., in the Journal of Clinical Epidemiology 59, pp. 1078-1086, 2006.

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