Study: Living in Immigrant Communities Doesn’t Affect TKA Outcomes

New work from the Hospital for Special Surgery (HSS) in New York has examined data from 3,898 total knee arthroplasties (TKAs) to determine if there were any outcome differences for patients living in immigrant communities.

The study, “Living in immigrant communities does not impact total knee arthroplasty outcomes: experience from a high-volume center in the United States,” appears in the January 31, 2019 edition of BMC Musculoskeletal Disorders.

Co-author Bella Mehta, M.B.B.S., M.D., a rheumatologist at HSS, explained the thinking behind the study and its results to OTW, “Previous research has identified individual-level social risk factors such as race, gender, or education that may result in poor outcomes after total knee arthroplasty (TKA). Community characteristics like poverty may also affect TKA outcomes.”

“Immigrants are increasingly recognized to be among these vulnerable groups in several medical outcomes, but it is unknown whether the proportion of the immigrants in a neighborhood influences TKA outcomes. Since TKA is one of the most widely-performed elective procedures with huge cost implications, we wanted to study if living in particular neighborhoods with high number of immigrants affects outcomes in any way.”

The authors assessed demographics, pre-op and two-year post-op WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index] pain and function scores, and geo-codable addresses. The effects of patient and neighborhood-level factors on WOMAC scores were analyzed.

“We found that pre-op and two-year post-op WOMAC pain and function scores were between 2.75-4.88 WOMAC points worse (on 100-point scale) in neighborhoods with a high immigrant proportion (≥ 40%) compared to low immigrant proportion (<10%). However, these differences were small, and not statistically significant after multivariable analyses.”

“While the multivariable analyses weren’t significant, they suggest that individual factors rather than neighborhood immigrant proportion may play a larger role in affecting TKA outcomes. The data suggests that more research is needed to develop and evaluate methods to attenuate the adverse effects of these individual-level risk factors.”

“While the results of this particular study were negative with respect to whether immigrant proportion has a direct effect on TKA outcomes, they still suggest that individual-level risk factors do have an effect. A large number of immigrants may have individual-level risk factors and are subject to poorer TKA outcomes—thus, an important consideration while seeing patients.”