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Kamath et al., 2010
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Sample of 185 patients receiving TKA in 2004. |
To determine the influence or race, gender, and BMI on primary TKA functional scores and ROM before gender-specific implants and whether comorbidities influence ROM and functional scores. |
Gender and race affected ROM and knee function scores. Blacks had longer delays to presentation, higher BMI, and worse 2-year knee function score. Women (all races) had higher BMI and worse preoperative flexion/arc ROM. Black women had worse final ROM.
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Lavernia et al., 2010
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Patients with a diagnosis of end-stage osteoarthritis who were scheduled for either primary or revision hip or knee arthroplasty. |
(1) To determine and compare function and quality of life between Blacks and Whites at clinical presentation and at an average follow-up of 5 years after surgery;
(2) To determine whether differences in fear and anxiety of pain exist between races before surgery; and
(3) To explore the relationship of anxiety and fear of pain before surgery with function and quality of life before and after surgery as a function of race. |
Blacks presented with worse scores on function, pain, physical function, and general health as compared with Whites both pre- and postoperatively. Blacks reported worse perceived general health and higher fear preoperatively compared with Whites.
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Singh et al., 2014
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Data from the U.S. Medicare Program (MedPAR data) for 1991–2008 to identify four separate cohorts of patients (primary TKA, revision TKA, primary THA, revision THA). |
To examine 30-day mortality following TKA and THA among Black and White Medicare beneficiaries at different time points. |
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Lavernia & Villa, 2015
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Retrospective sample using an institutional arthroplasty registry. 2,010 arthroplasties of which 1,446 were TKA and 564 were THA. |
(1) To examine whether Black patients have more severe or more frequent preoperative pain, well-being, general health, and disease-specific scores when compared with White patients.
(2) To examine whether there are differences between Black patients and White patients after hip or knee arthroplasty on those same measures. |
Black patients had more severe preoperative pain intensity and lower well-being and function scores. Black patients had more severe postoperative pain intensity and lower well-being and function scores. The differences were statistically significant but the differences were narrow and question the clinical significance.
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Goodman et al., 2016
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4,035 patients undergoing TKA enrolled in a hospital-based registry between 2007 and 2011 who provided 2-year outcomes and lived in New York, Connecticut, or New Jersey. |
(1) Are race and socioeconomic factors at the individual level associated with patient-reported pain and function 2 years after TKA?
(2) What is the interaction between race and community poverty and patient-reported pain and function 2 years after TKA? |
Fewer Blacks had a college education or above, Blacks had significantly higher BMI and significantly more comorbidities than Whites. More Blacks lived in high-poverty neighborhoods. Race, education, patient expectations, and baseline WOMAC scores are all associated with 2-year WOMAC pain and function; however, the effect sizes was small, and below the threshold of clinical importance. Whites and Blacks from census tracts with less than 10% poverty have similar levels of pain and function 2 years after TKA. With increasing community poverty, pain and function worsened; from census tracts with >50% poverty Blacks had clinically meaningful worse pain and function compared with Whites. Comorbidities and preoperative pain and function scores were associated with worse outcomes.
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Goodman et al., 2018
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4,170 THA cases who agreed to be part of an institutional registry for THA between May 1, 2007, and February 5, 2011, and with complete data. |
Determine whether neighborhood socioeconomic factors have a differential effect in Blacks and Whites on WOMAC pain and function 2 years after undergoing THA at the same high-volume hospital. |
Blacks had worse pain and function at baseline than White patients (7 points lower) despite presenting at a younger age and had more comorbidities than Whites at the time of surgery. WOMAC pain and function 2 years after THA are similar among Blacks and Whites in communities with little deprivation (low percent census tract Medicaid coverage). WOMAC function at 2 years is worse among Blacks in areas of higher deprivation. After controlling for relevant confounding variables, found that in addition to race and poverty, comorbidities and preoperative pain and function scores were associated with worse outcomes.
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Zhang et al., 2016
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Using all-payer state inpatient databases. |
Examined racial disparities in the TKA outcomes including mortality and complications. |
Rates of complications were significantly higher for Blacks and mixed-race individuals as compared with Whites. Minorities found to have an increased comorbidity burden overall. Obesity much higher for Blacks and Hispanics. The risk of perioperative mortality was significantly higher for Blacks, Native Americans, and mixed-race individuals compared with Whites.
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Larrieux, 2017
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CMS assessment and claims file from CMS Chronic Conditions Data Warehouse.
n = 249,060 beneficiaries undergoing THA in 2012 and receiving postacute care physical rehabilitation
through a Medicare-certified home healthcare agency. |
To examine whether there are racial disparities in functional outcomes (transfer abilities, ambulation) and hospital outcomes (home care days) in patients undergoing THA.
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Differences in function were found between Black and White patients after controlling for potentially confounding factors such as comorbidities, age, gender, and/or SES. 69% of Whites independent with transfer compared with 62% Black, 55% Hispanic. Hispanics five times more likely to be dependent compared with Whites. At time of discharge from home care, Blacks were 33% more likely to be dependent compared with Whites and Hispanics were 2.5 times more likely to be dependent when compared with Whites. Age and the number of comorbidities were predictors of the two primary outcomes of interest: transfers and ambulation/locomotion.
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Okike et al., 2019
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U.S. health-care system total joint replacement registry of persons undergoing elective primary THA between 2001 and 2016. |
To assess whether racial/ethnic disparities in THA outcomes persist in a universally
insured population of patients enrolled in an integrated healthcare system. |
The results demonstrate generally similar or better THA outcomes in minority populations (Black, Hispanic, and Asian compared with White) in the Kaiser Permanente network, a multihospital, multiregion integrated health system. The study population was largely a working population with reasonably high income and education levels across all racial groups. The controlled, closed-system environment of Kaiser Permanente is different from the community, insurance, and practice environment of the rest of the nation. Lifetime all-cause revision was lower for Black, Hispanic, and Asian patients. Ninety-day emergency department visits were more common among Black and Hispanic patients. For all other postoperative events (90-day deep infection, 90-day venous thromboembolism, 90-day mortality, and 90-day readmission), similar outcomes were achieved for Black patients although they had several risk factors for adverse outcomes (such as lower income, lower educational attainment, and a greater number of comorbidities). Minority patients had similar or lower rates compared with White patients.
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Amen et al., 2020
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Medicare and Medicaid services 2006–2015.
5,442,646 TKA procedures
2,644,193 THA procedures. |
To use a nationally representative sample to investigate trends in racial disparities in TJA (TKA and THA) complications between Black and White patients from 2006 to 2015. |
Black patients undergoing TKA had more complications across the study period and significantly worsened between 2006 and 2015 (2006: 5.1% vs. 6.1%; 2015: 3.9% vs. 6.0%). Inpatient mortality higher for Black patients although overall rare and downward trending for both races. TKA: After controlling for age, sex, smoking status, medical comorbidities, hospital characteristics, socioeconomic status, and insurance type, Black race was associated with increased mortality and complications (PE, DVT, wound dehiscence, sepsis, UTI, and acute renal failure). THA: After controlling for age, sex, smoking status, medical comorbidities, hospital characteristics, socioeconomic status, and insurance type, Black race was associated with increased mortality and total complications (PE, DVT, cardiac arrest, sepsis, UTI, and acute renal failure).
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Cavanaugh et al., 2020
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Data drawn from the Women's Health Initiative prospective study linked with Medicare claims data. Total sample size 10,325 women who underwent TKA between October 1, 1993, and December 31, 2014. |
To examine trajectories of physical functioning (PF) by race/ethnicity before and after TKA among older women. |
Black women had significantly poorer PF than White women during the decades before and after TKA. Hispanic women also had slightly lower preoperative PF scores than White women, but this difference was not statistically significant. Poorer PF after surgery was associated with poorer preoperative PF. Differences in pre-TKA PF between Black and White women were more pronounced among women with SES characteristics below median levels compared with those with higher SES levels. Reducing disparities should target maintenance of function preoperatively in the early stages of arthritic disease and/or reduction of delays to receiving TKA once need arises.
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Trivedi et al., 2020
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American College of Surgeons National Surgical Quality Improvement Program—all Black patients who underwent primary elective TKA between 2011 and 2017. n = 19,496 |
To examine recent annual trends in 30-day outcomes after primary elective TKA in a sample over time of Black patients. |
Over the study period, there were declining annual rates in LOS >2 days, any surgical complication, pulmonary embolism, DVT, and sepsis. 40% decline in 30-day adverse outcomes.
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