Age and Racial/Ethnic Disparities in Arthritis-Related Hip and Knee Surgeries

Background The benefits of TKA have been well documented. Whether these benefits apply equally across gender and ethnic groups is unclear. Given the underuse of TKA among certain demographic groups, it is important to understand whether gender or ethnicity influence pain and function after TKA. Questions/purposes We determined (1) the influence of race, gender, and body mass index (BMI) on primary TKA functional scores and ROM before gender-specific implants; and (2) months).Results African-Americans had longer delays to presentation, higher BMI, and worse 2-year KSS. Women (all races) had higher BMI and worse preoperative flexion/arc ROM. African-American women had worse final ROM and had similar final gains in ROM (postoperative minus preoperative ROM) after controlling for confounders. Conclusions Gender and race affected functional KSS and ROM variables. The worse results experienced by AfricanAmerican women may be attributable to a longer delay to presentation. However, the scores and motion were high for all subgroups, and underuse of TKA in women and AfricanAmericans cannot be justified based on a perception of lesser functional gains. Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ethnic and Gender Differences in the Functional Disparities after Primary Total Knee Arthroplasty

Kamath

Horneff

Gaffney

et al. 2010

“…Ethnic and racial disparities in care have been documented in many treatment realms [5][6][7]11]. Epstein et al [7] found ethnic minorities were less likely to be treated by highvolume surgeons at high-volume hospitals, with African Americans operated on by low-volume surgeons in lowvolume hospitals in nine of 10 procedures across the surgical spectrum studied at New York City area hospitals.…”

Section: Introductionmentioning

confidence: 99%

Minimizing Disparities in Osteoporosis Care of Minorities With an Electronic Medical Record Care Plan

Navarro

Greene

Burchette

et al. 2011

Background Ethnic disparities in care have been documented with a number of musculoskeletal disorders including osteoporosis. We suggest a systems approach for ensuring osteoporosis care can minimize potential ethnic disparities in care. Questions/purposes We evaluated variations in osteoporosis treatment by age, sex, and race/ethnicity by (1) measuring the rates of patients after a fragility fracture who had been evaluated by dual-energy xray absorptiometry and/or in whom antiosteoporosis treatment had been initiated and (2) determining the rates of osteoporosis treatment in patients who subsequently had a hip fracture. Patients and MethodsWe implemented an integrated osteoporosis prevention program in a large health plan. Continuous screening of electronic medical records identified patients who met the criteria for screening for osteoporosis, were diagnosed with osteoporosis, or sustained a fragility fracture. At-risk patients were referred to care managers and providers to complete practice guidelines to close care gaps. Race/ethnicity was selfreported. Treatment rates after fragility fracture or osteoporosis treatment failures with later hip fracture were calculated. Data for the years 2008 to 2009 were stratified by age, sex, and race/ethnicity. Results Women (92.1%) were treated more often than men (75.2%) after index fragility fracture. The treatment rate after fragility fracture was similar among race/ethnic groups in either sex (women 87.4%-93.4% and men 69.3%-76.7%). Osteoporotic treatment before hip fracture was more likely in white men and women and Hispanic men than other race/ethnic and gender groups. Conclusions Racial variation in osteoporosis care after fragility fracture in race/ethnic groups in this healthcare system was low when using the electronic medical record identifying care gaps, with continued reminders to osteoporosis disease management care managers and providers until those care gaps were closed.

“…Despite the documented benefits of TKA, racial and ethnic disparities have been reported in the utilization of TKA in the United States [2,4]. In addition to the disparities in TKA utilization, studies have also demonstrated disparities with respect to outcomes and complications of TKA [28].…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Above-knee Amputations After TKA: A National Database Study

George

Navale

Schiltz

et al. 2017

Background Above-knee amputation (AKA) is a rare but devastating complication of TKA. Although racial disparities have been previously reported in the utilization of TKA, it is unclear whether disparities exist in the rates of AKA after TKA. Questions/purposes (1) Which gender-racial group has the highest rate of AKA from septic and aseptic complications of TKA? (2) Which age groups have higher rates of AKA from septic and aseptic complications of TKA? Methods Using National Inpatient Sample data from 2000 to 2011, AKAs resulting from complications of TKA were identified using a combination of International Classification of Diseases, 9th Revision procedure and diagnosis codes. Of the 341,954 AKAs identified, 9733 AKAs were the result of complications of TKA (septic complications = 8104, aseptic complications = 1629). Standardized AKA rates were calculated for different age and gender-racial groups by dividing the number of AKAs in each group with the corresponding number of TKAs. Standardized rate ratios were calculated after adjusting for demographics and comorbidities. Results After adjusting for age and comorbidities, black men had the highest rate of AKA after TKA (adjusted rate in black men = 578 AKAs per 100,000 TKAs, standardized rate ratio [SRR] = 4.32 [confidence interval {CI},.82], p \ 0.001). Black men also had the highest rate of AKA after septic complications of TKA (p \ 0.001). The adjusted rates of AKA were higher in patients younger than 50 years (adjusted rate = 473, SRR = 3.14 [CI, 2.94-3.36], p \ 0.001) and older than 80 years (adjusted rate = 297, SRR = 1.85 [CI, 1.76-1.95], p \ 0.001). Conclusions The rising demand for TKA has led to an increase in the number of AKAs performed for complications of TKA in the United States. Although we did not find an increase in the rate of AKA during the study period, certain populations, including black men and patients older than 80 years and younger than 50 years, had higher rates of AKA. Further studies are required to understand the reasons for these disparities and measures should be undertaken to eliminate these disparities. Level of Evidence Level III, therapeutic study.