Conversely, males most reported concern is the length of rehabilitation time necessary for

the return of joint function (Ritter, et al. 1995).

Race and Arthroplasty

 The relationship between race and arthroplasty has been poorly studied. A recent

study in a large county in Texas reported that Hispanics were under represented as

recipients for hip replacement surgery (Escalante, Espinosa-Morales, Del Rincon,

Arroyo, & Older, 2000). In their research, African Americans were also less likely than

Caucasians to receive arthroplasty surgery. Extensive review of research literature on

race and arthroplasty, however, revealed no evidence to suggest a disparity in race and

arthroplasty.

 In summary, the number of total joint replacements increases dramatically for both

sexes after age 65 (Praemer, et al. 1999). The effect of this increase can be directly

attributed to the incidence of joint osteoarthritis, chronic pain and functional impairment

(Felson, 1988; Schlesinger, 2001). Women report greater functional impairment for all

activities of daily living and delay arthroplasty for a longer period of time. It is unclear

from previous research reasons for gender differences in osteoarthritis incidence or the

delay for surgical intervention. Previous research only verifies the age related changes of

osteoarthritis, functional impairment and the increase in total joint replacement surgery

for the relief of pain and improvement in physical function.

Spiritual Coping

 According to Lazarus, DeLongis, Folkman, and Gruen, (1985), "efficacy

expectations and appraisals refer to cognitions: fear and distress refer to emotional states

that includes cognitions" (p. 776). Stress is regarded as a complex variable and the

individual in his/her personal environment reflects the processing of these variables.