Background/Purpose: “Willingness” to undergo joint replacement surgery (JRS) is predictive of subsequent JRS among community-dwelling older adults and could, at least in part, explain the noted ethnic disparity in JRS utilization. Differences between African Americans and whites in JRS “willingness” have not been explored nor have other factors that affect willingness.

Methods: The Multicenter Osteoarthritis Study (MOST) is a prospective community-based study of 3026 adults 50-79 years old with or at risk of developing symptomatic knee or hip osteoarthritis (OA). Participants were from Birmingham, Alabama and Iowa City, Iowa. “Willingness to undergo JRS” was ascertained among participants at the 60-month visit as follows: “based on your understanding of the risks and benefits of hip and knee joint replacement surgery and if your symptoms were severe enough, would you be willing to have joint replacement surgery for your hips or knees?” Responses were coded “willing” or “not willing”. The following risk factors for willingness were assessed at the same time: age, gender, education, and race (African American and white); living situation (alone vs. with someone), comorbidity, OA radiographic severity, pain severity, function, depressive symptoms, pain catastrophizing, and study site. We excluded participants who already had a knee or hip replacement (N=438). We used logistic regression to examine the association of ethnicity with JRS willingness after adjusting for covariates.

Results: 1808 subjects who participated in the 60 month exam were included. The mean age of the sample was 67.7 (SD 7.8); 60% were female, 14% were African American, 27% did not have education beyond high school;18.4% lived alone; 11% had high depressive symptoms; 25% reported high pain catastrophizing.  In crude and adjusted models, African Americans were significantly less likely to report being “willing” to undergo JRS (Table 1).  Willingness declined with age and those from Alabama were less willing than subjects from Iowa. Men and persons with depressive symptoms tended to be less willing (p=0.06). Knee OA severity, pain severity, function, pain catastrophizing, andr living situation were not associated with willingness.

Conclusion: “Willingness” may explain some of the disparities in TKR utilization between African Americans and whites. Older and depressed persons and persons from certain locale’s may also be less willing to have TKRs and THRs. Longitudinal studies are needed to establish causality.

Table 1: Risk  Factors Associated with “Willingness” to Have a Total Joint Replacement (Odds Ratios below one signify decreased willingness to undergo THR or TKR; Bold highlight indicates p=0.05 significance)