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

Kamath, Atul F.; Horneff, John G.; Gaffney, Vandy; Israelite, Craig L.; Nelson, Charles L.

doi:10.1007/s11999-010-1461-y

Cited by 90 publications

(75 citation statements)

References 33 publications

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“…Postoperatively, black patients reported more pain as measured by the VAS and worse overall quality of wellbeing (QWB-7), general health (SF-36), and diseasespecific scores (WOMAC) when compared with white patients at a followup of at least 1 year after surgery. Our results are in agreement with the ones of Kamath et al [11]. The authors found that gender and race affected functional knee scores and ROM.…”

Section: Discussionsupporting

confidence: 94%

“…Unfortunately, studies [4,9,11] often fail to address race and ethnicity as separate entities and have compared Hispanics or Latinos with blacks, whites, or other races such as Native American or Alaska Native, Asian, Native Hawaiian, or other Pacific Islander [25]. The genetic background is linked to race, whereas its expression is influenced by cultural and/or environmental factors (like ethnicity).…”

Section: Introductionmentioning

confidence: 99%

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Does Race Affect Outcomes in Total Joint Arthroplasty?

Lavernia

Villa

2015

Clinical Orthopaedics &Amp; Related Research

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Background Several studies suggest worse surgical outcomes among racial/ethnic minorities. There is a paucity of research on preoperative and postoperative pain, general health, and disease-specific measures in which race is the main subject of investigation; furthermore, the results are not conclusive. Questions/purposes (1) Do black patients have more severe or more frequent preoperative pain, well-being, general health, and disease-specific scores when compared with white patients? (2) Are there differences between black patients and white patients after hip or knee arthroplasty on those same measures?Methods In this retrospective study, we used an institutional arthroplasty registry to analyze data on 2010 primary arthroplasties (1446 knees and 564 hips) performed by one surgeon at a single institution. Cases from patients selfidentifying as black (n = 105) and white (n = 1905) were compared (controlling for confounders, including age and ethnicity) on the following preoperative and postoperative patient-oriented outcomes: pain intensity/frequency as measured by a visual analog scale (VAS), Quality of Well-Being (QWB-7), SF-36, and WOMAC scores. Ttests, chi square, and multivariate analysis of covariance were used. Alpha was set at 0.05. Postoperative analysis was performed only on those cases that had a minimum followup of 1 year (mean, 3.5 years; range, 1-9 years). Of the 2010 arthroplasties, 37% (39 of 105) of those cases performed in black patients and 64% (1219 of 1905) of those performed in white patients were included in the final postoperative model (multivariate analysis of covariance). Results Black patients had more severe preoperative pain intensity (VAS: 8 ± 1.8 versus 8 ± 2.0, mean difference = 0.76 [95% confidence interval {CI}, 0.34-1

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Does Race Affect Outcomes in Total Joint Arthroplasty?

Lavernia

Villa

2015

Clinical Orthopaedics &Amp; Related Research

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“…However, our institution provides surgical care for referrals from other institutions as well as primary orthopedic care to the local population (similar to community-based practices). The similarity of our cohort to other published studies (50–52) as well as the NIS sample (6), and similarity in magnitude of increase in comorbidity to the recent NIS study (6) support our sample’s representativeness and the generalizability of these findings. We adjusted our multivariable-adjusted analyses for several important covariates, but residual confounding is possible in a cohort study.…”

Section: Discussionsupporting

confidence: 84%

Time Trends in the Characteristics of Patients Undergoing Primary Total Knee Arthroplasty

Singh

Lewallen

2014

Arthritis Care & Research

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Objective To study the time-trends in socio-demographic and clinical characteristics of patients undergoing primary total knee arthroplasty (TKA). Methods We used the Mayo Clinic Total Joint Registry to examine the time-trends in patient demographics (body mass index [BMI], age), underlying diagnosis, medical (Deyo-Charlson index) and psychological comorbidity (anxiety, depression) and examination findings of primary TKA patients from 1993–2005. We used chi-square test and analysis of variance. Results 7,229 patients constituted the primary TKA cohort; 55% were women. The mean age decreased by 1.3 years (69.3 to 68.0), BMI increased by 1.7 kg/m2 (30.1 to 31.8) and Deyo-Charlson index increased by 36% (1.1 to 1.5) over the 13-year study period (p<0.001 for all). Compared to 1993–95, significantly more patients (by 2–3 times) in 2002–05 had (p<0.001 for all): BMI ≥40, 4.8% vs. 10.6%; age <50, 2.9% vs. 5.2%; Deyo-Charlson index of ≥3, 12% vs. 22.3%; depression, 4.1% vs. 14.8%; anxiety, 4.1% vs. 8.9%; and a significantly fewer had an underlying diagnosis of rheumatoid/inflammatory arthritis, 6.4% vs. 1.5%. Compared to 1993–95, significant reductions were noted in 2002–05 for the physical examination findings of (p<0.001 for all): knee joint effusion, anterior-posterior knee instability, medial-lateral knee instability, moderate-severe knee synovitis, severe limp, fair or poor muscle strength and absent peripheral pulses. Conclusions In this large U.S. total joint registry study, we found significant time-trends in patient characteristics, diagnosis, comorbidity and knee/limb examination findings in primary TKA patients over 13-years. These secular trends should be taken into account when comparing outcomes over time and in policy-making decisions.

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“…Our overall study and the qualitative portion included few persons from racial and ethnic minority groups. We are unable to say whether our results apply to patients more marginalized or challenged in their TKA experience through language or racial or minority status [51, 52]. These results do not explore the experiences of those who never receive TKA surgery in the first place, either by their decision to not have surgery or by being less likely to be offered surgery [53].…”

Section: Discussionmentioning

confidence: 99%

The importance of informational, clinical and personal support in patient experience with total knee replacement: a qualitative investigation

Goldsmith

Suryaprakash

Randall

et al. 2017

BMC Musculoskelet Disord

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BackgroundTotal knee arthroplasty (TKA) is the most frequently performed joint replacement surgery in North America. Patient perspectives on TKA have been investigated in various ways, including finding as many as 20% of TKA patients are dissatisfied with their surgical outcomes. Understanding the patient experience with TKA broadly and in relation to patient satisfaction is a key gap in existing literature.MethodsWe report on the qualitative component of a mixed methods prospective cohort study examining patient experience and satisfaction post-TKA for adults in British Columbia, Canada. Data collection consisted of 45 in-depth interviews about individuals’ knee surgery experiences conducted eight months after surgery. Analysis consisted of thematic coding by multiple coders.ResultsParticipants’ descriptions of their TKA experiences were primarily concerned with support, or the provision of aid and assistance. Support was insufficient when their expectations of support were not met; unmet support expectations led to an overall negative TKA experience. Support operated in three key domains: (1) informational support, (2) clinical support, and (3) personal support. Key sources of informational and clinical support included pre-optimisation clinics, surgeons, and physiotherapists. Key topics for informational support included pain, pain management, and recovery trajectories. Personal support was provided by family, friends, other TKA patients, employers, and themselves.ConclusionsPatient needs and expectations for support are shaped both before and after TKA surgery. Patients with an overall positive TKA experience had improvement in their knee pain, stiffness or functioning post-TKA, had their major expectations and needs for support met during their TKA recovery, and believed that any significant future expectations or needs for ongoing support would be adequately met. In contrast, patients with an overall negative TKA experience had at least one major expectation or need for support not met during their TKA recovery, even in cases where they had good TKA outcomes. Suggested interventions to improve the experience of persons receiving TKA include an expanded patient navigator model, revised pre-surgery educational materials, particularly around pain expectations and management, and comprehensive sharing of other patients’ TKA experience.

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

Cited by 90 publications

References 33 publications

Does Race Affect Outcomes in Total Joint Arthroplasty?

Does Race Affect Outcomes in Total Joint Arthroplasty?

Time Trends in the Characteristics of Patients Undergoing Primary Total Knee Arthroplasty

The importance of informational, clinical and personal support in patient experience with total knee replacement: a qualitative investigation

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