Does racial background influence outcomes following total joint arthroplasty?

Abstract

Background: The purpose of this study is to assess whether racial differences influence patient-reported outcome measures (PROMs) following primary total hip (THA) and knee (TKA) arthroplasty. Methods: We retrospectively reviewed patients who underwent primary THA or TKA from 2016 to 2020 with available PROMs. Both THA and TKA patients were separated into three groups based on their ethnicity: Caucasian, African-American, and other races. Patient demographics, clinical data, and PROMs at various time-periods were collected and compared. Demographic differences were assessed using chisquare and ANOVA. Univariate ANCOVA was utilized to compare outcomes and PROMs while accounting for demographic differences. Results: This study included 1999 THA patients and 1375 TKA patients. In the THA cohort, 1636 (82%) were Caucasian, 177 (9%) were African-American, and 186 (9%) were of other races. In the TKA cohort, 864 (63%) were Caucasian, 236 (17%) were African-American, and 275 (20%) were of other races. Surgicaltime significantly differed between the groups that underwent THA (88.4vs.100.5vs.96.1; p < 0.001) with African-Americans requiring the longest operative time. Length-of-stay significantly differed in both THA (1.5vs.1.9vs.1.8; p < 0.001) and TKA (2.1vs.2.5vs.2.3; p < 0.001) cohorts, with African-Americans having the longest stay. Caucasians reported significantly higher PROM scores compared to non-Caucasians in both cohorts. All-cause emergency-department (ED) visits, 90-day postoperative events (read-missions&revisions), and discharge-disposition did not statistically differ in both cohorts. Conclusion: Non-Caucasian patients demonstrated lower PROM scores when compared to Caucasian patients following TJA although the differences may not be clinically relevant. LOS was significantly longer for African-Americans in both THA and TKA cohorts. Further investigation identifying racial disparity interventions is warranted.

Racial and Socioeconomic Differences in Distance Traveled for Elective Hip Arthroplasty

“…1,2 Prior research has demonstrated disparities in access to care and outcomes after joint arthroplasty operations. [3][4][5] Singh et al 3 found that African American patients had longer average length Matthew Orringer, BA…”

“… 1 , 2 Prior research has demonstrated disparities in access to care and outcomes after joint arthroplasty operations. 3 - 5 Singh et al 3 found that African American patients had longer average length of stay after both THA and total knee arthroplasty (TKA), while White patients had higher patient-reported outcome measure scores. Another study found that White patients, those with commercial insurance coverage, and those earning greater than $25,000 per year had a shorter average length of stay.…”

Surgeon and Facility Volumes Are Associated With Social Disparities and Post-Operative Complications After Total Hip Arthroplasty

“…Additionally, it is possible that some of the low volume facilities are "safety net" hospitals, which could explain some of the socioeconomic differences between patient populations seen in the study. Overall, such differences in patient populations raise concerns regarding patient care, especially considering that non-White patients have reported lower patient-reported outcome measures [33]. Naturally, these findings suggest interconnected and multifactorial causes and thus require further investigation to yield effective interventions.…”

Disparities across Diverse Populations in the Health and Treatment of Patients with Osteoarthritis

“…Results showed that compared to Caucasian patients, African-American patients demonstrated lower PROM scores following TJA. Surgical-time and length-of-stay significantly differed between the groups (p < 0.001); Black patients who underwent THA required the longest operative time and spent longer in hospital following THA/TKA compared to White patients [67].…”

“…Another study, performed by Singh and colleagues, investigated whether racial differences influenced patient-reported outcome measures (PROMs) following primary THA and TKA between 2016 and 2020 [67]. Participants included 1999 THA patients and 1375 TKA patients.…”