Introduction: Racial disparities have been well reported in the utilization and outcomes of knee arthroplasty, but it is unclear whether disparities also extend to the choice of surgical treatment. The primary objective of this study is to identify if race plays a role in the selection of unicondylar versus total knee arthroplasty (UKA, TKA) for isolated tibiofemoral osteoarthritis (OA). A secondary objective is to identify the differences in the complication rates for each procedure by racial identity.
Methods: A retrospective review of the 2006-2018 American College of Surgeons National Surgical Quality Improvement Program was performed. Asian, Black, Hawaiian/Pacific Islander, Hispanic, Native American/Alaskan, and White individuals who underwent primary elective UKA or TKA were compared in terms of UKA vs. TKA utilization rates and outcomes.
Results: A total of 308,715 patients were analyzed. After controlling for all baseline differences, Whites (3.5%), Asians (3.7%), and Hawaiian/Pacific Islanders (3.1%) had around twice the rate of UKA compared to Blacks (1.6%), while Hispanics (2.1%) and Native American/Alaskans (1.7%) were in between (p <0.001). TKA was associated with higher complications compared to UKA in all racial groups (p < 0.001).
Conclusion: Minority patients, especially Blacks, were less likely to receive UKA for treatment of isolated knee OA. This is significant because treatment selection in patients who are eligible for UKA can have a significant impact on postoperative recovery and complications rates.
Keywords: Disparities; Osteoarthritis; Total knee arthroplasty; Treatment selection; Unicondylar knee arthroplasty.
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