The Association of Race/Ethnicity and Total Knee Arthroplasty Outcomes in a Universally Insured Population

Adrian D Hinman; Priscilla H Chan; Heather A Prentice; Elizabeth W Paxton; Kanu M Okike; Ronald A Navarro

doi:10.1016/j.arth.2020.02.002

The Association of Race/Ethnicity and Total Knee Arthroplasty Outcomes in a Universally Insured Population

J Arthroplasty. 2020 Jun;35(6):1474-1479. doi: 10.1016/j.arth.2020.02.002. Epub 2020 Feb 8.

Authors

Adrian D Hinman¹, Priscilla H Chan², Heather A Prentice², Elizabeth W Paxton², Kanu M Okike³, Ronald A Navarro⁴

Affiliations

¹ Department of Orthopaedic Surgery, The Permanente Medical Group, San Leandro, CA.
² Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA.
³ Department of Orthopaedic Surgery, Kaiser Moanalua Medical Center, Honolulu, HI.
⁴ Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, CA.

PMID: 32146110
DOI: 10.1016/j.arth.2020.02.002

Abstract

Background: Prior studies have documented racial/ethnic disparities in the United States for total knee arthroplasty (TKA) outcomes. One factor cited as a potential mediator is unequal access to care. We sought to assess whether racial/ethnic disparities persist in a universally insured TKA population.

Methods: A US integrated health system's total joint replacement registry was used to identify elective primary TKA (2000-2016). Racial/ethnic differences in revision and 90-day postoperative events (readmission, emergency department [ED] visit, infection, venous thromboembolism, and mortality) were analyzed using Cox proportional hazard and logistic regression with adjustment for confounders.

Results: Of 129,402 TKA, 68.8% were white, 16.2% were Hispanic, 8.4% were black, and 6.6% were Asian. Compared to white patients, Hispanic patients had lower risks of septic revision (hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.57-0.83) and infection (odds ratio [OR] = 0.42, 95% CI = 0.30-0.59), but a higher likelihood of ED visit (OR = 1.28, 95% CI = 1.22-1.34). Black patients had higher risks of aseptic revision (HR = 1.61, 95% CI = 1.42-1.83), readmission (OR = 1.13, 95% CI = 1.02-1.24), and ED visit (OR = 1.31, 95% CI = 1.23-1.39). Asian patients had lower risks of aseptic revision (HR = 0.67, 95% CI = 0.54-0.83), septic revision (HR = 0.78, 95% CI = 0.60-0.99), readmission (OR = 0.89, 95% CI = 0.79-1.00), and venous thromboembolism (OR = 0.59, 95% CI = 0.45-0.78).

Conclusion: We observed differences in TKA outcome, even within a universally insured population. While lower risks in some outcomes were observed for Asian and Hispanic patients, the higher risks of aseptic revision and readmission for black patients and ED visit for black and Hispanic patients warrant further research to determine reasons for these findings to mitigate disparities.

Level of evidence: Level III.

Keywords: emergency department visit; race; readmission; revision surgery; total knee arthroplasty.

MeSH terms

Arthroplasty, Replacement, Knee* / adverse effects
Black or African American
Elective Surgical Procedures
Ethnicity
Hispanic or Latino
Humans
Retrospective Studies
United States / epidemiology