Race and Sex Differences in Willingness to Undergo Total Joint Replacement: The Johnston County Osteoarthritis Project


  • The findings and conclusions contained herein are those of the authors and do not necessarily represent the official position of the CDC or the Department of Veterans Affairs.



Using data from the community-based Johnston County Osteoarthritis Project, we examined race and sex variations in willingness to undergo, and perceptions regarding, total joint replacement (TJR).


Analyses were conducted for the total sample who participated in a followup measurement period from 2006–2010 (n = 1,522) and a subsample with symptomatic hip and/or knee osteoarthritis (sOA; n = 445). Participants indicated how willing they would be to have TJR (hip or knee) if their doctor recommended it; responses were categorized as “definitely” or “probably” willing versus “unsure,” “probably not,” or “definitely not” willing, or “don't know.” Participants answered 7 questions regarding perceptions of TJR outcomes. Multivariable logistic regression models of willingness included participant characteristics (including socioeconomic status) and TJR perception variables that were associated with willingness at the P < 0.1 level in bivariate analyses.


African Americans had lower odds of willingness to undergo TJR than whites in the total sample (adjusted odds ratio [OR] 0.47 [95% confidence interval (95% CI) 0.31–0.72]) and the sOA subsample (adjusted OR 0.42 [95% CI 0.25–0.69]). There were no sex differences in willingness. African Americans expected poorer TJR outcomes than whites, but sex differences were minimal; perceptions of TJR outcomes were not significantly associated with willingness.


In this community sample, race differences in TJR willingness and perceptions were substantial, but sex differences were small. Perceptions of TJR did not appear to affect willingness or explain race differences in willingness.