Racial Disparities Inhibit Use of TKRs

There are marked racial differences in the utilization of total knee replacement (TKR) surgery on the part of white and African-American patients.

Using Medicare claims data, a study reported on by writer Bill Schu and published in Arthritis Research & Therapy, estimated that the annual rate of TKR was 4.84 per 1, 000 among African-American women, compared to 5.97 per 1, 000 among white women. They found that the rate for African-American men (1.84 per 1, 000) was dramatically lower than that for white men (4.82 per 1, 000). The study suggested that patient preferences may be responsible.

Schu quoted the researchers as saying, “Reasons for racial disparities in TKR utilization rate are complex and involve patient-level, provider-level and system-level factors. Patient preference has emerged as a key factor. It is a strong predictor of time to receipt of a first total joint replacement.”

In studies of veterans with advanced knee or hip osteoarthritis (OA), African-Americans were consistently less willing to consider joint replacement when compared to whites, wrote Schu.

Participants in the study came from the University of Pittsburgh and the Veterans Affairs, Pittsburgh Healthcare System clinics and were recruited via mailed solicitations and advertisements—514 white and 285 African-American patients with chronic knee pain and radiographic evidence of OA participated in the study.

The study found that when compared to whites, African-Americans were less willing to undergo TKRs. The numbers were 80% vs. 62%, respectively. Whites are more likely to believe that TKR is efficacious. They were also more likely to be familiar with the procedure than were African-Americans who were more likely to expect surgical complications than were whites.

A further problem, the researchers noted, may have been poor communication with health care providers.

The study authors concluded that educational strategies and training targeted towards healthcare professionals may also improve patient trust in physicians and the healthcare system. The hope was to steer patients towards more effective and evidence-based treatments, including TKR. “Eventually, ” they wrote, “we may be able to personalize intervention programs and reduce racial disparities in the utilization of TKR among OA patients.”