Minorities more skeptical about joint replacements

NEW YORK (Reuters Health) - Minority patients may take a dimmer view of the risks of hip and knee replacements, relative to their white counterparts, new study findings suggest.

Canadian researchers found that of patients having joint replacement surgery at one Toronto hospital, black and Asian men and women perceived the surgery as riskier than white patients did.

Numerous studies have found that black patients with serious arthritis are less likely than their white counterparts to have joint replacement surgery. The current findings suggest that racial differences in patients' perceptions of the risks of the surgery may be one reason, the researchers say.

The research team, led by Dr. Rajiv Ghandi of the University of Toronto, surveyed 1,609 patients who were scheduled to have hip or knee replacement surgery. All were being treated by one of two surgeons at a single hospital, and all were given the same information about the potential risks and benefits of the procedure.

After those consultations, the researchers asked the patients whether they thought it was likely their surgery would be successful, and whether they felt they were likely to have complications.

In general, Ghandi's team found, patients who were black or of Asian descent perceived joint replacement as more risky than white patients did. They also tended to be in worse shape, reporting greater pain and disability than their white counterparts.

This latter finding, according to the researchers, could be related to minority patients' greater skepticism about surgery. That is, they may have been more likely to put off surgery until their pain and disability became too great.

However, when the researchers assessed the patients after surgery, they found that on the whole, black and Asian patients were faring as well as white patients.

It's not clear why minority patients had a dimmer outlook on joint replacement, since they had the same surgeons and the same pre-surgery information, according to the researchers.

One reason, they speculate, could be familiarity with the procedure.

Other studies have shown that white patients are more likely than black patients to have already heard of joint replacement surgery and to know someone who'd had the surgery. In contrast, black patients are more likely than whites to know someone who'd had the surgery and suffered complications.

According to Ghandi's team, "simply communicating the evidence for the effectiveness of a treatment to a patient may not be enough to alleviate their uncertainty about surgery."

Future studies, they conclude, should look at how doctors can better explain the benefits and risks of medical procedures.

SOURCE: Journal of Rheumatology, August 2008.