Black, Hispanic Patients: Less Robotic-Assisted Knee Surgery?

In the first population-level study which collected data regarding computer-assisted knee arthroplasty in the ICD-10 era (after 2015), a multicenter team found that there are substantial patient population access differences to these new technologies.

The study, “Trends in Practice Patterns of Conventional and Computer-assisted Knee Arthroplasty: An Analysis of 570,671 Knee Arthroplasties Between 2010 and 2017,” was published in the November 15, 2021 edition of the Journal of the American Academy of Orthopaedic Surgeons.

Hassan Ghomrawi, Ph.D., M.P.H., associate professor of surgery at the Feinberg School of Medicine at Northwestern University in Chicago, explained to OTW the genesis of this work. “Although smaller studies that analyzed the utilization patterns of conventional knee arthroplasty and computer-assisted knee arthroplasty existed, none of these were population-level studies that gave insight on the recent trends of utilization in the ICD-10 era (post 2015). Smaller studies showed the clinical importance of computer-assisted knee arthroplasty using ICD-10 data, however, there were no population-level studies that looked at the extent to which utilization of computer-assisted knee arthroplasty has increased in the ICD-10 era.”

As for why Dr. Ghomrawi thinks this hasn’t been previously studied, he added, “In the transition from ICD-9 to ICD-10 coding, there has been a significant increase in the volume and specificity of codes. This poses a challenge in that many ICD-9 codes cannot be linked one-to-one with another ICD-10 code, but rather, in most cases, one ICD-9 code matches to several ICD-10 codes. I believe the biggest obstacle in analyzing the utilization of conventional knee arthroplasty and computer-assisted knee arthroplasty in the post ICD-9 era was cross walking the ICD-9-CM and ICD-10-CM codes for conventional knee arthroplasty and computer-assisted knee arthroplasty.”

“Additionally, studying the utilization patterns of conventional knee arthroplasty and computer-assisted knee arthroplasty across both the ICD-9 and ICD-10 eras required access to databases and multiple year population/state level data sets that may not be available to all researchers.”

Regional, Racial Differences

“Although utilization of computer-assisted knee arthroplasty increased substantially in both New York and Florida from 2010-2017, an almost 200% increase, it still represented less than 10% of cases done in these two states. In addition, Black and Hispanic patients and those with Medicaid insurance were the least likely to receive this higher-precision technology.”

“This manuscript is the first study to examine computer-assisted knee arthroplasty trends using ICD-10-CM codes, providing more recent insight on the uptake and utilization patterns of conventional knee arthroplasty and computer-assisted knee arthroplasty in the post ICD-9 era. Given the benefit realized from computer-assisted technology, our findings have important implications for increasing uptake of this advancing technology and for addressing health disparities in access to this higher-precision technology.”