Black Patients Had Lower Utilization Rates and Higher Acute Mortalities After Total Knee Arthroplasty

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Health Equity

Background:

• Barriers related to race, ethnicity, socioeconomic status, geography, and sex can impact total knee arthroplasty (TKA) access and outcomes.
• Understanding disparities in TKA utilization and outcomes is crucial for improving patient care.

Purpose of the Study:

• To compare the utilization rates and postoperative outcomes of TKA between Black and White patients within a large integrated health system.
• To identify potential racial disparities in TKA access and outcomes.

Main Methods:

• Retrospective study of 17,079 patients (932 Black, 16,147 White) undergoing primary TKA for osteoarthritis (2016-2023).
• Compared demographic factors, comorbidities (Elixhauser Comorbidity Index), and postoperative complications (30-day and 90-day mortality, readmissions) between racial groups.
• Analyzed TKA utilization rates against population data and hospital-specific performance.

Main Results:

• Black patients were younger, had higher BMIs, and greater comorbidity burden compared to White patients.
• Black patients experienced significantly higher rates of 30-day (OR: 7.0) and 90-day mortality (OR: 5.7) post-TKA.
• TKA utilization was lower than expected for Black patients in 8/17 hospitals and higher than expected for White patients in 13/17 hospitals.

Conclusions:

• Black patients face significantly higher mortality risks following TKA compared to White patients.
• Total knee arthroplasty is underutilized among Black patients relative to White patients within this health system.
• Racial disparities exist in both TKA utilization and postoperative outcomes.