Patients with limited English proficiency are more likely to receive elective total joint arthroplasty than English-proficient patients

Patients who have limited English proficiency (LEP) are more likely to receive elective total joint arthroplasty than fully English-proficient (FEP) patients — an unadjusted 46% versus 38% surgery rate and roughly 20% higher adjusted odds — a pattern that runs counter to the common expectation that language barriers reduce access to elective procedures.

Provenance / grounding caveat (reviewer flag). The PDF filed under this citekey (@Angeles_2026_Elective_Total) is NOT the Angeles et al. primary study; it is a Letter to the Editor by Zirvecan Güneş, MD (J Arthroplasty 41 (2026) e20–e21; DOI 10.1016/j.arth.2025.09.004) commenting on the Angeles study. The numeric findings below (46% vs 38%; ~20% adjusted odds) are the Angeles study's results restated secondhand in the Güneş letter. This claim therefore has no primary-data EVD from the available PDF. To ground it properly, the actual Angeles et al. primary article (J Arthroplasty 2026;41:674–9; DOI 10.1016/j.arth.2025.07.065) must be obtained and its results extracted as EVD(s).

Grounding quotes (from the Güneş commentary letter) #

"The point that caught my attention is that patients who don't speak English fluently (LEP group) are getting arthroplasty surgery at a much higher rate than those who speak English well (FEP group) (46% compared to 38%). This seems counterintuitive to say the least." (Güneş, 2026, p. e20)

"In summary, the study by Angeles et al. highlights a connection between limited English skills and increased rates of elective total joint surgeries. This finding goes against the common belief that language barriers hinder access to these procedures and raises some important questions." (Güneş, 2026, p. e21)