A Comparison of Joint Replacement Disparities in VA and Non-VA Settings

The purpose of this systematic review was to compare what is known about disparities in total joint replacement (TJR) surgery in VA settings with disparities in civilian health care settings. The leading cause of disability in the United States is osteoarthritis. There is no known cure. Consequently, osteoarthritis is managed with a variety of treatments to reduce disability, improve function, and alleviate symptoms. When conservative treatments fail, surgical intervention is indicated. The most effective surgical option for moderate to severe osteoarthritis in the knee or hip is total joint replacement (TJR). TJR is often considered appropriate in cases where other non-surgical treatments have not brought adequate relief. TJR in the management of end-stage osteoarthritis is widely utilized and is considered the fastest growing elective surgery in the nation, if not the world. Although TJR is highly successful at treating advanced kip or knee osteoarthritis, there is substantial evidence that disparities exist in TJR utilization in non-VA settings, with racial and ethnic disparities being the most documented. This report compares what is known about disparities in TJR in the VA context with disparities in non-VA settings. The review focused on three key questions: Key Question #1: What is the evidence about the existence and magnitude of disparities in joint replacement surgery in VA? How does this compare to published studies from non-VA US populations? Key Question #2: What is the evidence about the patient level, provider level, and system level factors that contribute to disparities in joint replacement surgery in VA? How does this compare to published studies from non-VA populations? Key Question #3: What is the evidence regarding VA or non-VA interventions to reduce disparities in joint replacement surgery?