Ethnic variation in knee replacement: Patient preferences or uninformed disparity?

Maria E. Suarez-Almazor, Julianne Souchek, P. Adam Kelly, Kimberly O'Malley, Margaret Byrne, Marsha Richardson, Chong Pak

Research output: Contribution to journalArticlepeer-review

115 Scopus citations


Background: Despite the efficacy and cost-effectiveness of total knee replacement (TKR), minority patients with knee osteoarthritis (OA) are half as likely as their white counterparts to undergo this procedure. Patient preferences may play a large role in the variations in utilization of TKR. We evaluated the preferences and beliefs of patients with knee OA from diverse ethnic backgrounds in relation to TKR. Methods: The 198 patients with knee OA surveyed were of different ethnicities. Patients were asked about physician recommendations of TKR and whether they had considered having the procedure, their perceptions about the benefits and risks of TKR, their expectations if they were to undergo the procedure, and their trust in physicians and the health system. Bivariate and multivariate analyses were performed. Results: A physician had discussed TKR with 27% of African Americans, 15% of whites, and 11% of Hispanics (P = .04). White patients were more likely than minority patients to have considered undergoing TKR (P = .04), more likely to consider TKR if their OA worsened and the procedure were recommended by their physician (P = .002), and more likely to consider TKR as a beneficial procedure (P = .02). Ethnic differences in preferences remained after controlling for severity of OA. Conclusions: Ethnic minority patients with knee OA are less likely to consider TKR. In our study, these differences were not related to physician recommendation biases. The ethnic variation in preferences was associated with differences in perception of benefit, lack of personal experiences with TKR, and trust.

Original languageEnglish (US)
Pages (from-to)1117-1124
Number of pages8
JournalArchives of internal medicine
Issue number10
StatePublished - May 23 2005

ASJC Scopus subject areas

  • Internal Medicine


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