Clinical Appropriateness and Not Race Predicted Referral for Joint Arthroplasty
Dennis C. Ang, MD, MS,1 Golda James, MD,1 and Timothy E Stump, MA2Hip Knee
Objective
To understand the reasons behind racial disparities in the use of total joint arthroplasty (TJA), we sought to examine the predictors of time to referral to orthopedic surgery for consideration of joint replacement.
Method
In this prospective, longitudinal study of 676 primary care clinic patients with at least moderately severe degree of hip or knee osteoarthritis (OA), we examined the effects of race, health beliefs (i.e., perceived benefits and risks of TJA) and clinical appropriateness of TJA on referral to orthopedic surgery.
Results
Sample included 255 (38%) African Americans and 421 (62%) whites; 523 (78%) patients with knee OA and 153 (22%) with hip OA. Subjects were 60% male, with a mean (± SD) age of 64 ± 9 years, a mean body mass index of 33.6 ± 8 kg/m2, and a mean summary WOMAC score of 56 ± 14, suggesting moderately severe OA. At baseline, African Americans perceived fewer benefits and greater risk from TJA than whites. There were no significant racial group differences in the proportions of those deemed clinically appropriate for TJA. After controlling for potential confounders, clinical appropriateness (hazard ratio (HR) =1.95, 1.15-3.32, p=0.01) predicted referral to orthopedic surgery. Neither race (HR=1.30, 0.94-2.05, p=0.1) nor health beliefs (HR=1.0, p=0.5) were associated with referral status.
Conclusions
In this sample of primary care clinic patients, African Americans and whites were equally likely to be referred by their physicians to orthopedic surgery. Clinical appropriateness predicted future referral to orthopedic surgery and not race or TJA-specific health beliefs.
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