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

Despite increasing demand for total knee arthroplasty (TKA), barriers such as race, ethnicity, socioeconomic background, geographic variation, and sex influence patients' decisions or ability to undergo surgery and are known to affect postoperative outcomes. We compared utilization rates and postoperative outcomes of TKA between Black and White patients within our large integrated health system.

A retrospective study was performed for Black and White patients who underwent primary TKA for osteoarthritis within our health system between January 2016 and December 2023. The final analysis included 17,079 patients. White patients numbered 16,147 (94.5%) while Black patients numbered 932 (5.5%). Black patients were younger (64 versus 67 years, P < 0.05), exhibited higher average body mass indexes (37.6 versus 35.6, P < 0.05), and had higher Elixhauser Comorbidity Index scores (mean: 2.7 versus 2.2, P < 0.05). Incidence of Centers for Medicare and Medicaid Services defined postoperative complications describing short-term mortality, readmissions, and other morbid complications were evaluated. The incidence of TKA for Black and White patients was compared to population data to evaluate utilization. Independent t-tests, Chi-squares, logistic regressions, odds ratios (OR), areas under the curve (AUC), and goodness of fit testings were done. Significance was set to P < 0.05.

Black patients had significantly higher rates of 30-day mortality (OR: 7.0, confidence interval [CI]: 1.8 to 27.6, AUC: 0.7; P = 0.005) and 90-day mortality (OR: 5.7, CI: 1.8 to 18.4, AUC: 0.8; P = 0.003). All other postoperative complications were similar between groups. In eight of 17 hospitals, Black patients had significantly less than expected TKAs performed, while in 13 of 17 hospitals, White patients had significantly more than expected TKAs performed.

Black patients have significantly higher rates of 30- and 90-day mortality following TKA, while simultaneously underutilizing this procedure, when compared to their White counterparts.