Racial Disparities in Total Knee and Hip Arthroplasty in a Medically Underserved Community with a Diverse Population

Gabriel Alemayehu; Brett Jones; Katherine Slack; Sahir S Jabbouri; Robert Greene; Richard Roux; Craig McAllister

doi:10.1007/s40615-023-01891-0

Racial Disparities in Total Knee and Hip Arthroplasty in a Medically Underserved Community with a Diverse Population

J Racial Ethn Health Disparities. 2023 Dec 12. doi: 10.1007/s40615-023-01891-0. Online ahead of print.

Authors

Gabriel Alemayehu¹, Brett Jones², Katherine Slack², Sahir S Jabbouri³, Robert Greene⁴, Richard Roux⁴, Craig McAllister²

Affiliations

¹ Washington State University, Elson S. Floyd College of Medicine, Spokane, WA, USA. gabriel.alemayehu@wsu.edu.
² Washington State University, Elson S. Floyd College of Medicine, Spokane, WA, USA.
³ Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, New Haven, CT, USA.
⁴ Orthopedics Northwest, Yakima, WA, USA.

PMID: 38085463
DOI: 10.1007/s40615-023-01891-0

Abstract

Introduction: Previous studies have demonstrated lower total joint arthroplasty utilization rates and worse postoperative outcomes among non-White patients. Our study examined whether these disparities exist in the setting of a diverse population.

Methods: This retrospective study included patients with a self-reported race who underwent total knee (TKA) or hip (THA) arthroplasty procedures in a racially diverse county. Patients who did not identify as White or Hispanic/Latino were excluded from the study due to small sample sizes. Demographic, intra and postoperative outcome differences were calculated. A multivariate logistic regression was developed to examine the association between patients' race and undesired postoperative outcomes.

Results: Five hundred fifty-five patients were included in our study with 490 identifying as non-Hispanic/Latino White (88.8%) and 65 as Hispanic/Latino (11.2%). Hispanic/Latino-identifying patients were significantly younger (61.9 ± 12.79 versus 68.58 ± 9.00 years), had lower Charlson Comorbidity Index scores, and were more likely to use non-Medicare/Medicaid insurance. We observed no differences between our cohorts in postoperative adverse events, emergency department visits, and hospital readmissions. Patients' self-identified race was not correlated with undesired postoperative outcomes.

Conclusions: Although Hispanic/Latino-identifying patients constitute 50.2% of the county population of our study cohort, they accounted for only 11.2% of the patients in our study. This is noteworthy considering the lack of evidence suggesting a decreased prevalence of osteoarthritis among individuals of different races and ethnicities. Further, the demographic differences we observed suggest an exclusive Hispanic/Latino patient population utilizing TKA or THA procedures. Future studies controlling for risk factors and less invasive treatment options may explain these disparities.

Keywords: Arthroplasty; Osteoarthritis; Racial disparities; Surgical outcomes.