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Racial and Ethnic Disparities in Hip and Knee Joint Replacement: A Review of Research in the Veterans Affairs Health Care System

Dr. Ibrahim is Associate Professor of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, and Executive Committee Member, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.

Neither Dr. Ibrahim nor the departments with which he is affiliated have received anything of value from or own stock in a commercial company or institution related directly or indirectly to the subject of this article.

Elective total joint arthroplasty is an effective treatment option for end-stage osteoarthritis of the hip and knee. The demand for arthroplasty is anticipated to increase as the proportion of older patients with hip and knee osteoarthritis continues to rise in the United States and worldwide. Studies have documented marked racial and ethnic differences in the utilization rates of hip and knee arthroplasty in the United States. The reasons for these differences are complex and include patient-level factors, such as treatment preference; provider-level factors, such as physician-patient communication style; and system-level factors, such as access to specialist care. Most of the studies on racial and ethnic disparities in joint arthroplasty utilization have been based on data from the Medicare database. However, Veterans Administration–based studies have recently confirmed these findings and have indicated potential patient-level factors, such as patient perception of and familiarity with joint arthroplasty, that may play a role in this disparity.