Racial Disparity in Arthroplasty Utilization Rates and Outcomes

To what extent does a patient’s race affect their decision to have a lower-extremity arthroplasty, participate in the care decisions, follow post-operative protocols and, therefore…realize an optimal outcome from lower extremity arthroplasty surgery?

A new systematic review of the literature by the Ohio State University Wexner Medical Center in Columbus offers some insights. The study, “Race, Utilization, and Outcomes in Total Hip and Knee Arthroplasty: A Systematic Review on Health-Care Disparities,” appears in the March 2022 edition of JBJS Reviews.

Co-author Sravya P. Vajapey, M.D., M.B.A., an orthopedic surgeon with the Wexner Medical Center explained the objectives of the study to OTW, “This research comes at a time when disparities and inequities have come to light in all industries across society, including healthcare. It shows that lower-extremity total joint arthroplasty is not immune to these inequalities and provides data to support changes in our practice are required to make healthcare equal, accessible, and equivalent to all despite racial differences. Our study also presents important information to orthopaedic surgeons at a time when patient satisfaction and post-operative outcomes play a larger role in compensation after procedures.”

Avoiding Mis-Informed Decisions – By Physician and Patient

“As access to healthcare increases with the development of more affordable healthcare plans, orthopaedic surgeons can have a better understanding of what patients from minority backgrounds understand prior to being seen in their office and, in turn, to allow for patients to make more informed decisions regarding their treatment plan. Lastly, it brings attention to the lack of ability to understand and follow rehabilitation protocols which could decrease complications and readmission rates if acted upon.”

Homing in on all studies with a level of evidence of I through IV published over the last 20 years (in English), the team conducted a MEDLINE search using keywords such as “disparities,” “arthroplasty,” “race,” “joint replacement,” “hip,” “knee,” “inequities,” “inequalities,” “health,” and “outcomes.”

Systemic Disparities Between White, Black, Hispanic and Asian Patients

Dr. Vajapey: “Our systematic review summarized and analyzed the findings within a total of 82 articles focused on the effect of patient race on utilization and expected outcomes of lower-extremity arthroplasty.”

“It demonstrated that, when compared with White patients:

• Black, Hispanic, and Asian patients had lower utilization of lower-extremity total joint arthroplasty,
• Black and Hispanic patients had lower expectations regarding post-operative outcomes and their ability to participate physical activities following surgery,
• Black and Hispanic patients were less likely to be educated on the procedure prior to being evaluated by an orthopaedic surgeon,
• Black and Hispanic patients presented for surgery with poorer pre-operative function,
• Black and Hispanic patients also had increased risk of complications, readmissions and having the procedure completed at a low-quality, low-volume hospital when compared with White patients.”

“This research brings awareness to the healthcare disparities present surrounding the utilization and expected outcomes following total hip and knee arthroplasty in minority populations. It exemplifies the importance of providing patient centered care both pre- and post-operatively. In the pre-operative setting, patients from minority populations can benefit from more detailed educational materials regarding the indications for lower extremity total joint arthroplasty.”

Reducing Racial Disparities in Care and Outcome

“In an effort to reduce racial disparities:

• orthopaedic surgeons can offer closer follow-up after their initial evaluation,
• make a greater effort to discuss the details of the procedure and how the patient may benefit,
• it is imperative for orthopaedic surgeons ensure their patients are playing an active role during the clinical decision-making process,
• communicate with patient in their preferred language of communication,
• use an interpreter if needed,
• post-operatively, ensure that patients have a safe discharge plan, have the social support to care for themselves and participate in rehabilitation protocols,

provide further education on what they can expect following the procedure.”