A new study of 102,727 women of varying ethnicities has found significant differences in the rates of total knee arthroplasty (TKA) between black, white, and Hispanic women. The study, “Racial and ethnic disparities in utilization of total knee arthroplasty among older women,” appears in the August 9, 2019 edition of Osteoarthritis and Cartilage.
Landmark TKA Utilization Study Finds Vast Racial Disparities
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The team looked at data from 8,942 black, 3,405 Hispanic, and 90,420 white women with linked Medicare claims data, following them until date of TKA, death, or transition from fee-for-service.
Alyson Cavanaugh, P.T., Ph.D., with the Department of Family Medicine and Public Health at the University of California, San Diego and study co-author, explained the results of this landmark study to OTW. “Among women with activity-limiting arthritis, black women and Hispanic women were significantly less likely to undergo total knee arthroplasty than white women. Lower socioeconomic status did not explain the racial and ethnic differences in utilization. Black and Hispanic women with end-stage knee arthritis may be underutilizing an effective treatment that could improve mobility and quality of life.”
“Our study adds to the growing body of evidence that finds socioeconomic status is not driving these disparities, with current evidence suggesting that patients of minority race/ethnicity may, in fact, not be considering surgery due to factors including a lack of knowledge of the procedure, misconceptions about the surgery and recovery process, and a mistrust of medical community.”
“Among patients of minority race/ethnicity, the shared decision-making process should ensure that true information-sharing and communication occurs. While cultural beliefs and preferences should be respected, it is important that patients are making an informed decision regarding treatment.”
“Black and Hispanic patients may be less likely to consider joint replacement as an option for treating end-stage arthritis. Ensuring that patients truly comprehend the risks, benefits, and expectations of surgery may be important to their decision-making.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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